3D导航下改良透视法监测经皮逆行螺钉治疗髋臼前柱骨折的疗效

Effect of modified fluoroscopic monitoring in treatment of acetabular anterior column fractures with percutaneous retrograde screw fixation under computer-assisted 3D navigation

目的探讨3D导航辅助下改良透视法监测经皮逆行髋臼前柱拉力螺钉置入治疗髋臼前柱骨折的疗效。方法采用回顾性病例系列研究分析2013年12月—2016年12月解放军中部战区总医院收治的42例髋臼前柱骨折患者临床资料,其中男24例,女18例;年龄20~61岁[(41.6±12.9)岁]。均采用3D导航辅助下逆行经皮髋臼前柱拉力螺钉固定术治疗,共置入髋臼前柱螺钉61枚。观察每枚螺钉置入时间、术中出血量、透视时间,对比术中透视及术后影像螺钉符合率,并观察并发症情况。术后6个月采用D'Aubigné-Poste L功能评分评估患侧髋关节功能。术后12个月观察骨折愈合情况及并发症情况。结果患者均获随访9~18个月[(13.1±3.2)个月]。螺钉置入时间为(18.7±4.8)min,术中出血量为(16.6±3.8)ml,术中透视时间为(25.3±10.9)s。术中透视与术后影像对比螺钉符合率为100%。均未出现神经血管损伤、血栓形成、伤口感染、异位骨化、长期疼痛等并发症。术后6个月D'Aubigné-Poste L功能评分为(10.7±0.9)分,较术前(8.7±1.6)分有明显改善(P<0.05)。所有患者骨折愈合。术后12个月2例患者(3枚螺钉)患肢活动能力下降,2例患者(2枚螺钉)出现螺钉松动。结论对于髋臼前柱骨折,3D导航辅助下改良透视法监测经皮逆行髋臼前柱螺钉置入,有助于减少术中透视时间,提高置钉精度,降低手术风险,从而改善髋关节功能。

Objective To investigate the effect of modified fluoroscopic monitoring in the treatment of acetabular anterior column fractures with percutaneous retrograde screw fixation under computer-assisted 3D navigation.Methods A retrospective case series analysis was performed on the clinical data of 42 patients with acetabular anterior column fractures admitted to Central Theater Command General Hospital of PLA from December 2013 to December 2016.There were 24 males and 18 females,with the age of 20-61 years[(41.6±12.9)years].All patients underwent percutaneous retrograde acetabular anterior column screw fixation under computerassisted 3D navigation.A total of 61 screws were inserted.The observation indexes included the time for insertion of each screw,intraoperative bleeding volume,fluoroscopy time,coincidence rate between intraoperative fluoroscopy and postoperative imaging,and complications.The D`Aubigné-Postel system was used to evaluate the hip joint function at postoperative 6 months.Fracture healing and complications were detected at postoperative 12 months.Results All patients were followed up for 9-18 months[(13.1±3.2)months].Time for insertion of each screw was(18.7±4.8)min,intraoperative bleeding volume was(16.6±3.8)ml,fluoroscopy time was(25.3±10.9)s,and coincidence rate between intraoperative fluoroscopy and postoperative imaging was 100%.There were no complications such as neurovascular injury,thrombosis,wound infection,heterotopic ossification and longterm pain.Six months after operation,D`Aubigné-Postel function score was(10.7±0.9)points,significantly improved compared with preoperative(8.7±1.6)points(P<0.05).Two patients(3 screws)had lower limb mobility and two patients(2 screws)had screw loosening.Conclusion For acetabular anterior column fractures,percutaneous retrograde acetabular anterior column screw placement assisted by 3D navigation is helpful to improve the accuracy of screw insertion,decrease introperative fluoroscopy time,reduce operation risk,improve screw coincidence rate,and therefore improve hip function.