计算机虚拟技术联合骨盆复位架治疗骨盆C型骨折的疗效

Effect of computer virtual technique combined with pelvic reduction frame in the treatment of type C pelvic fracture

目的:探讨计算机虚拟技术联合骨盆复位架闭合复位经皮螺钉固定治疗复杂骨盆骨折的近期临床疗效。方法:回顾性分析2018年4月至2020年4月采用骨盆复位架经皮微创治疗的30例Tile C型骨盆骨折患者,男21例,女9例,年龄19~57(39.40±9.85)岁。将患者的骨盆CT DICOM数据导入Mimics软件重建骨折虚拟模型,在骨折模型上进行虚拟复位及置钉,然后进行模拟透视记录理想的透视方位和角度以指导术中正确透视。记录手术时间、透视次数和术中出血量。患者骨折复位质量采用Matta影像评分标准评价,术后功能采用Majeed功能评分标准评价。结果:30例患者均实现了闭合复位经皮螺钉固定,根据Matta评分标准骨折复位优良率为93.3%(28/30);共置入通道螺钉67枚,置钉优良率98.5%(66/67)。手术时间(173.54±79.31)min,术中透视次数(90.81±41.11)次,术中出血量(81.21±43.97)ml。所有切口Ⅰ期愈合,无断钉、无骨折再移位。所有患者随访满12个月,末次随访时Majeed功能评分73~94(85.66±5.33)分。结论:计算机虚拟技术联合骨盆复位架可快速、准确和安全地复位和固定不稳定骨盆骨折,计算机虚拟技术有助于外科医生对骨盆骨折的认识和理解,骨盆复位架可提高外科医生闭合处理复杂不稳定骨盆损伤的能力。

Objective:To investigate the short-term clinical effect of the computer virtual technique combined with pelvic reduction frame in the treatment of complex pelvic fractures.Methods:Thirty patients with Tile C pelvic fractures treated by percutaneous minimally invasive pelvic reduction frame from April 2018 to April 2020 were retrospectively analyzed,including 21 males and 9 females,aged from 19 to 57(39.40±9.85)years old.The patient's pelvic CT DICOM data were imported into Mimics software to reconstruct the virtual fracture model.Virtual reduction and nail placement were carried out on the fracture model,and then simulated fluoroscopy was carried out to record the ideal fluoroscopy orientation and angle to guide the correct fluoroscopy during operation.The operation time,fluoroscopy times and intraoperative blood loss were recorded.The quality of fracture reduction was evaluated by Matta image score standard,and the postoperative function was evaluated by Majeed function score standard.Results:All 30 patients achieved closed reduction and percutaneous screw fixation.According to Matta score,the excellent and good rate of fracture reduction was 93.3%(28/30).A total of 67 channel screws were inserted,and the excellent and good rate was 98.5%(66/67).The operation time was(173.54±79.31)min,fluoroscopy time was(90.81±41.11)times,intraoperative blood loss was(81.21±43.97)ml.All incisions healed at one stage without broken nails or re-displacement of fractures.All patients were followed up for 12 months.At the final follow-up,Majeed function score was 73 to 94(85.66±5.33)scores.Conclusion:Computer virtual technology combined with pelvic reduction frame could rapidly,accurately and safely reduce and fix unstable pelvic fractures.Computer virtualization could help surgeons to recognition and understanding pelvic fractures,pelvic reduction frame could improve the surgeon's ability to manage complex and unstable pelvic injuries.