O-arm导航辅助下经皮骶髂关节螺钉内固定治疗骶髂关节复合体损伤

Percutaneous sacroiliac screw fixation assisted by O-arm navigation in treatment of sacroiliac joint complex injury

目的比较O-arm导航辅助下与C形臂X线机透视辅助下经皮骶髂关节螺钉内固定治疗骶髂关节复合体损伤的临床疗效。方法采用回顾性病例对照研究分析2016年7月—2019年1月陆军军医大学第二附属医院收治的32例骶髂关节复合体损伤患者临床资料,其中男21例,女11例;年龄20~59岁,平均41.3岁。骨折按Tile分型:B1型7例,B2型13例,B3型5例,C1型5例,C2型2例。17例采用O-arm导航辅助下经皮骶髂螺钉内固定治疗(A组),15例采用C形臂X线机透视辅助下经皮骶髂螺钉内固定治疗(B组)。比较两组单枚螺钉置钉时间、术中透视时间、术中出血量、骨折愈合时间,采用Matta标准评分评价术后骨折复位质量。采用Majeed功能评分评价末次随访时关节功能,并观察并发症情况。结果患者均获随访6~37个月,平均18.6个月。A组单枚螺钉置钉时间为(27.3±5.1)min,B组为(52.3±5.9)min(P<0.05)。A组术中透视时间为(43.3±3.2)s,B组为(64.6±5.4)s(P<0.05)。A组术中出血量为(17.8±2.6)ml,B组为(20.7±3.1)ml;A组骨折愈合时间为(13.4±1.4)周,B组为(14.1±1.9)周;A组和B组Matta标准评分的优良率分别为88%(15/17)和87%(13/15);A组和B组末次随访时Majeed评分的优良率分别为94%(16/17)和87%(13/15)(P均>0.05)。术后B组1例患者出现1枚螺钉稍突破椎体前皮质。两组均无血管、神经损伤、伤口感染、螺钉松动等并发症。结论与C形臂X线机透视辅助下相比,O-arm导航辅助下经皮骶髂关节螺钉内固定治疗骶髂关节复合体损伤具有置钉时间短、术中透视时间短等优势。

Objective To compare the clinical effect of percutaneous sacroiliac screw fixation assisted by O-arm navigation or C-arm X-ray fluoroscopy in the treatment of sacroiliac joint complex injury.Methods A retrospective case-control study was conducted on 32 patients with sacroiliac joint complex injury admitted to Second Affiliated Hospital of Army Medical University from July 2016 to January 2019.There were 21 males and 11 females,aged from 20 to 59 years(mean,41.3 years).According to Tile classification,there were 7 patients with type B1 fracturs,13 with type B2,5 with type B3,5 with type C1,and 2 with type C1.Group A(n=17)had percutaneous sacroiliac screw fixation assisted by O-arm navigation,while Group B(n=15)had percutaneous sacroiliac screw fixation assisted by C-arm X-ray fluoroscopy.Time of single screw placement,time of intraoperative fluoroscopy,intraoperative bleeding volume and bone union time were measured.Reduction quality was evaluated by Matta standard score.Majeed function score was assessed 6 months at the latest follow-up.Complications were also observed.Results All patients were followed up for 6-37 months(mean,18.6 months).The time of sacroiliac joint screw placement[(27.3±5.1)minutes]and time of intraoperative fluoroscopy[(43.3±3.2)s]in Group A were significantly less than those in Group B[(52.3±5.9)minutes,(64.6±5.4)s](P<0.05).There were no significant differences between Group A and Group B in intraoperative bleeding[(17.8±2.6)ml vs.(20.7±3.1)ml]and bone union time[(13.4±1.4)weeks vs.(14.1±1.9)weeks](P>0.05).According to the reduction quality evaluated by Matta standard score,the good and excellent rate was 88%(15/17)in Group A and 87%(13/15)in Group B(P>0.05).The good and excellent rate of the Majeed function score was 94%(16/17)in Group A and 87%(13/15)in Group B at the latest follow-up(P>0.05).One patient in Group B demonstrated one screw slightly penetrating the anterior cortex of vertebral body.No neurovascular injury,wound infection,or screw loosening occurred.Conclusion For sacroiliac joint complex injury,percutaneous sacroiliac screw fixation assisted by O-arm navigation has advantages in the duration of screw placement and intraoperative fluoroscopy over percutaneous sacroiliac screw fixation assisted by C-arm X-ray fluoroscopy.