导航下空心螺钉内固定治疗骶髂复合体损伤的疗效观察

Navigation-Assisted Percutaneous Iliosacral Cannulate Screw in Treating Sacroiliac Complex Injury

目的探讨导航技术引导下应用经皮空心螺钉在骶髂复合体(sacroiliac complex,SIC)损伤中的安全性、有效性及术中注意事项。方法自2016年1月到2018年12月中国人民解放军中部战区总医院骨科采用3D导航技术经皮空心螺钉内固定治疗35例SIC损伤患者,其中男24例,女11例;年龄19~67岁,平均(35.2±3.5)岁。记录置钉时间、术中出血量、神经血管损伤及术后并发症。术后应用Matta放射学标准对复位质量评价,末次随访采用Majeed标准对骨盆功能进行评价。结果35例患者共置入空心螺钉39枚,无一例患者出现神经、血管损伤。平均每枚螺钉置入时间为(41.5±4.3)min,术中出血量约(15.5±10.3)mL。2例Morel-Lavallée损伤患者经切开清创+深部置管引流+负压封闭引流(vacuum sealing drainage,VSD)后愈合良好;1例患者螺钉突破骨皮质,但无神经血管损伤;1例患者术后1个月随访时发现螺钉退出约1 cm,后期随访螺钉未继续后退。术后依据Matta放射学标准对SIC复位质量进行评价,优良率为88.57%。所有患者均获得随访,随访时间9~18个月,平均(12.5±2.3)个月。末次随访时采用Majeed标准对骨盆功能进行评价,优良率为91.43%。结论导航技术引导下经皮置入空心螺钉是一种精准微创、安全有效的治疗SIC损伤手术方法,值得临床推广应用。

Objective To investigate the clinical effect,safety and technique notes for the navigation-assisted percutaneous cannulate screw fixation in treating patient with the sacroiliac complex injury.Methods Thirty-five cases of patients with the sacroiliac complex injury who had been collected from January 2016 to December 2018 were treated using percutaneous cannulate screw fixation with three-dimensional navigation-assisted system in the central hospital of PLA.There were 24 males and 11 females,aged 19 to 67 years,with an average age of(35.2±3.5)years.Intraoperative indexes as duration,blooding volume,nerve or blood vessel lesion and postoperative complications were respectively documented.Condition was postoperatively evaluated by Matta radiological criteria.Pelvic function was assessed by Majeed scoring criteria at the last follow-up.Results Thirty-five cases with 39 screws in all were placed without neurovascular complications.Each screw averagely took(41.5±4.3)mins with bleeding of(15.5±10.3)mL.Two patients with Morel-Lavallée injury underwent open debridement and VSD(vacuum sealing drainage).Intraoperatively,one patient broke through the cortical bone into the pelvic cavity,but no obvious neurovascular complications.One screw moved backward for 1 cm at the 1 st month of follow-up,and this abnormal process was controlled by the reasonable intervention.Matta radiological evaluation presented the excellent rate with 88.57%.All patients were followed up from 9 to 18 moths,average(12.5±2.3)months.The Majeed standard of pelvic function evaluation in the last follow up showed the excellent rate with 91.43%.Conclusion It can conclude that three-dimensional navigation-assisted percutaneous cannulate screw fixation in treating patient with the sacroiliac complex injury is an accurate,minimally invasive,safe and effective,which is worthy of clinical application.