O形臂导航下通道螺钉治疗Ⅱ型老年脆性骨盆骨折的疗效

Efficacy of channel screw guided by O-arm navigation for the treatment of type II fragile fracture of pelvis in the elderly

目的:探讨O形臂导航下通道螺钉治疗Ⅱ型老年脆性骨盆骨折(FFP)的疗效。方法:采用回顾性队列研究分析2019年9月至2021年4月复旦大学附属浦东医院骨科收治的37例Ⅱ型FFP患者的临床资料,其中男9例,女28例;年龄65~82岁[(71.8±10.1)岁]。15例采用O形臂导航下通道螺钉固定治疗(手术组),22例采取非手术治疗(非手术组)。比较两组急诊时、治疗后1周、1,3,6个月视觉模拟评分(VAS)、Majeed功能评分,记录手术组置钉准确率,以及治疗和随访期间并发症情况。结果:患者均获随访6~18个月[(13.2±5.1)个月]。两组急诊时VAS及Majeed功能评分差异无统计学意义(P均>0.05)。两组治疗后6个月VAS低于急诊时,Majeed功能评分高于急诊时(P均<0.01)。治疗后1周手术组VAS为2(1,4)分,低于非手术组的4(3,5)分(P<0.01);治疗后1个月手术组VAS为1(1,2)分,低于非手术组的3(2,5)分(P<0.05)。治疗后1周手术组Majeed功能评分为(50.2±4.2)分,高于非手术组的(40.2±5.6)分(P<0.01);治疗后1个月手术组Majeed功能评分为(73.8±5.2)分,高于非手术组的(62.4±5.0)分(P<0.01)。而治疗后3个月及6个月两组VAS和Majeed功能评分差异无统计学意义(P均>0.05)。手术组置钉准确率为93%(14/15)。手术组出现尿路感染1例,术中螺钉穿出1例,无螺钉松动及神经、血管损伤,并发症发生率为13%(2/15);非手术组出现尿路感染5例,坠积性肺炎5例,深静脉血栓1例,并发症发生率为50%(11/22)(P<0.05)。结论:与非手术治疗相比,O形臂导航下通道螺钉治疗Ⅱ型老年FFP可早期缓解疼痛并促进功能恢复、实现螺钉精准置入、降低并发症发生率。

Objective To evaluate the clinical efficacy of channel screw guided by O-arm navigation for the treatment of type II fragile fracture of pelvis(FFP)in the elderly.Methods A retrospective cohort analysis was performed on clinical data of 37 patients with type II FFP admitted to Shanghai Pudong Hospital,Fudan University Pudong Medical Center from September 2019 to April 2021.There were 9 males and 28 females,aged 65-82 years[(71.8±10.1)years].A total of 15 patients receipt channel screw fixation under O-arm navigation(surgical group)and 22 patients were treated conservatively(non-surgical group).The visual analogue scale(VAS)and Majeed functional score were compared between the two groups at emergency visit and at 1 week,1 month,3 months,6 months after treatment.The accuracy of screw insertion and complications were also recorded during treatment and follow-up.Results All patients were followed up for 6-18 months[(13.2±5.1)months].There were no significant differences in the VAS and Majeed functional score between the two groups at emergency visit(all P>0.05).In both groups,lower VAS and higher Majeed functional score were found at 6 month after treatment as compared with those at emergency visit(all P<0.01).The VAS in surgical group was 2(1,4)points at 1 week after treatment,lower than 4(3,5)points in non-surgical group(P<0.01).The VAS in surgical group was 1(1,2)points at 1 month after treatment,lower than 3(2,5)points in non-surgical group(P<0.05).The Majeed functional score in surgical group was(50.2±4.2)points at 1 week after treatment,higher than(40.2±5.6)points in non-surgical group(P<0.01).The Majeed functional score in surgical group was(73.8±5.2)points at 1 month after treatment,higher than(62.4±5.0)points in non-surgical group(P<0.01).The two groups had no significant differences in VAS and Majeed functional score at 3 months and 6 months after treatment(all P>0.05).The accuracy of screw insertion in surgical group was 93%(14/15).In surgical group,the complication rate was 13%(2/15),including urinary tract infection in 1 patient and intraoperative screw penetration in 1,with no screw loosening or nerve and vascular injuries.In non-surgical group,the complication rate was 50%(11/22),including urinary tract infection in 5 patients,penetrating pneumonia in 5 and deep vein thrombosis in 1.The complication rate was significantly different between the two groups(P<0.05).Conclusions Compared with non-surgical treatment,the channel screw insertion guided by O-arm navigation can achieve precise screw placement,relieve pain early,promote functional recovery,realize accurate insertion of the screw and reduce the complication rate for type II FFP in the elderly.