3D导航与C型臂X线机透视下经皮双节段长骶髂关节螺钉内固定治疗骨盆后环损伤的疗效比较

3D navigation versus C-arm fluoroscopy for placement of percutaneous double-segment long sacroiliac screws in treatment of injury to posterior pelvic ring

目的比较3D导航与C型臂X线机透视辅助下经皮双节段长骶髂关节螺钉内固定治疗骨盆后环损伤的临床疗效。方法回顾性分析2015年2月至2020年10月期间解放军中部战区总医院骨科采用经皮双节段长骶髂关节螺钉内固定治疗的48例骨盆后环损伤患者资料。根据辅助置钉方式不同分为两组:3D导航组27例,男19例,女8例;年龄为(45.5±7.4)岁;采用3D导航辅助置钉。透视组21例,男14例,女7例;年龄为(44.1±10.1)岁;采用C型臂X线机透视辅助置钉。比较两组患者每枚骶髂关节螺钉的置入时间、置入每枚螺钉的X线透视时间、导针调整次数、螺钉位置、骨折复位质量、骨折愈合时间、骨盆功能及术后并发症发生情况等。结果两组患者术前一般资料的比较差异均无统计学意义(P>0.05),具有可比性。3D导航组患者术中每枚螺钉置入时间[(12.7±2.2)min]、置入每枚螺钉的X线透视时间[(40.7±9.3)s]和导针调整次数[1(0,1)次]均显著少于透视组患者[(23.7±3.6)min、(71.4±14.1)s、5(4,6)次],螺钉位置评级(优49例,良4例,差1例)显著优于透视组患者(优29例,良8例,差5例),差异均有统计学意义(P<0.05)。48例患者术后获8~25个月(平均13.1个月)随访。两组患者的骨折愈合时间、骨折复位质量及骨盆Majeed功能评分比较差异均无统计学意义(P>0.05)。透视组1例患者出现L5神经根损伤症状。术后无一例患者出现伤口感染、螺钉松动及断裂等并发症。结论与C型臂X线机透视相比,3D导航辅助下经皮双节段长骶髂关节螺钉内固定治疗骨盆后环损伤可明显缩短螺钉置入时间、置入螺钉的X线透视时间,并减少导针调整次数,提高螺钉置入的位置准确率。

Objective To compare the efficacy of 3D navigation versus C-arm fluoroscopy for placement of percutaneous double-segment long sacroiliac screws in the treatment of injury to the posterior pelvic ring.Methods A retrospective study was conducted in the 48 patients with pelvic fracture who had been treated surgically from February 2015 to October 2020 at Department of Orthopaedics,General Hospital of Central Command of PLA.The patients were divided into a navigation group and a fluoroscopy group according to their different auxiliary ways to assist screw placement.In the navigation group of 27 patients,there were 19 males and 8 females,with an age of(45.5±7.4)years;in the fluoroscopy group of 21 patients,there were 14 males and 7 females,with an age of(44.1±10.1)years.The 2 groups were compared in terms of placement time for each screw,fluoroscopy time for each screw,adjustments of guide wire,accuracy of screw position,quality of fracture reduction,fracture union time,pelvic function,and postoperative complications.Results The 2 groups were comparable because there was no significant difference between them in the preoperative general data(P>0.05).The placement time for each screw[(12.7±2.2)min],fluoroscopy time for each screw[(40.7±9.3)s]and adjustments of guide wire[1(0,1)time]in the navigation group were significantly less than those in the fluoroscopy group[(23.7±3.6)min,(71.4±14.1)s and 5(4,6)times](all P<0.05);the assessment of screw placement in the former(49 excellent,4 good and one poor cases)was significantly better than that in the latter(29 excellent,8 good and 5 poor cases)(P<0.05).The 48 patients were followed up for 8 to 25 months(mean,13.1 months).There were no significant differences between the 2 groups in fracture union time,quality of fracture reduction or Majeed scores for the pelvic function(all P>0.05).Symptoms of injury to the L5 nerve root were observed in one patient in the fluoroscopy group;none of the patients reported postoperative complications like wound infection,screw loosening or breaking.Conclusions Compared with C-arm fluoroscopy,3D navigation may better assist placement of percutaneous double-segment long sacroiliac screws in the treatment of injury to the posterior pelvic ring,because 3D navigation can significantly shorten the time for screw placement and the fluoroscopy time for screw placement,reduce adjustments of guide wire,and improve accuracy of screw placement.