CT体表定位法经皮骶髂螺钉治疗垂直不稳定骨盆骨折的疗效评价

Evaluation of the efficacy of transcutaneous sacroiliac screws in the treatment of vertical unstable pelvic fractures with CT surface localization

目的通过比较CT体表定位法与常规透视法行经皮骶髂关节螺钉固定治疗Tile C型骨盆骨折的临床疗效,探讨CT体表定位法治疗垂直不稳定型骨盆骨折的优越性。方法选择2012年5月至2015年10月我院收治的37例无明显神经症状单侧或双侧Tile C型闭合骨盆骨折和骶髂关节脱位患者为研究对象,随机分为常规透视法组(19例)和CT体表方法透视组(18例)。比较两种手术方式的时间、术中出血量、X线暴露次数、切口总长度及骶髂螺钉的偏出率;运用Matta标准和Majeed标准对末次随访患者功能疗效进行评定。结果体表定位法组手术时间(29.54±1.91)min、X线暴露次数(19.16±0.73)次均显著优于常规透视法组患者,差异有统计学意义(P<0.05);但术中出血量(16.54±9.29)ml、切口总长度(2.26±0.71)cm及螺钉偏出率5.56%与常规透视法组患者比较,差异无统计学意义(P>0.05);两组患者末次随访Matta评分、Majeed评分比较,差异均无统计学意义(P>0.05)。结论 CT体表定位法组治疗垂直不稳定型骨盆骨折,在体表定位标记引导下,经皮置入骶髂关节螺钉,能够缩短手术透视时间,减少术中X线暴露次数,并有效降低螺钉进入椎管、腹腔风险,减少损伤血管、神经损伤,显著提高置钉成功率。

Objective To evaluate the clinical efficacy of transcutaneous sacroiliac joint screw fixation in the treatment of pelvic fracture of the Tile type C by comparison of body surface localization and conventional fluoroscopy, and to explore the superiority of transcutaneous sacroiliac joint screw fixation on vertical unstable pelvic fracture.Methods Thirty-seven patients with Tile C-type pelvic fractures, hospitalized in our hospital during May 2012 and October 2015 and without obvious nerve symptom, were randomly divided into two groups： conventional fluoroscopy group （n = 19） and modified fluoroscopy group （n = 18 ）. The clinical efficacy was evaluated by observing clinical data such as operative time, blood loss, hospital days, X-ray exposure, incision Length and probability of screw out. The function efficacy of patients was evaluated based on Matta standard and Majeed criteria during the last follow-up.Results Operation time of surface positioning method group （29.54± 1. 91min） and X- ray exposure （ 19.16 ± 0.73times） were significantly better than the conventional fluoroscopy group, the differences were statistically significant （P〈0.05）. But the amount of intra-operative bleeding （ 16.54 ±9.29） ml, the total length of incision （2.26±0.71cm） and screw off the rate （5.56%） were similar the conventional fluoroscopy group, the differences were not statistically significant （P〉0.05）. Compared Matta score and Majeed score at the last follow-up, there were no significant differences （P〉 0. 05）. Conclusions Percutaneous sacroiliac joint screw fixation for the treatment of vertical unstable pelvic fractures, percutaneous placement of sacroiliac joint screws under the guidance of surface localization marks, can shorten the fluoroscopy time and reduce the number of X-ray exposure during operation, and effectively reduce the risk of screw into the spinal canal and abdominal cavity, reduce damage to blood vessels, nerves, has significant guiding significance.