骨盆前环入口位结合闭孔出口位透视辅助下经皮置入耻骨支螺钉的临床研究

Clinical study of percutaneous insertion of pubic ramus screw with the help of perspective at the anterior pelvic ring inlet position combined with the obturator outlet position

目的:探讨骨盆前环入口位结合闭孔出口位透视辅助下经皮置入耻骨支螺钉的临床效果。方法:回顾性分析2020年1月至2021年1月收治的25例髋臼前柱骨折患者。男14例,女11例;年龄22~73岁,平均(41.3±11.6)岁。所有患者术前于CT上测量骨盆前环入口位透视角度。术中使用C型臂X线机在骨盆前环入口位结合闭孔出口位透视技术辅助下经皮置入骨盆前环耻骨支通道螺钉,术后采用CT验证耻骨支螺钉位置。结果:25例患者共植入32枚螺钉,其中逆行耻骨支螺钉20例,顺行耻骨支螺钉12例。每枚螺钉置入时间为20~32 min,平均(21.9±1.5)min;术前测量骨盆前环入口位角度为31.2°~38.9°,平均35.38°±3.63°,在男女患者之间无统计学差异(P>0.05)。术后采用CT验证,所有耻骨支螺钉均位于前环骨通道内,无螺钉错位、突破前后侧骨皮质等情况发生。25例患者术后随访时间为7~12个月,平均(8.5±1.2)个月。骨折愈合时间为16~24周,平均(18.0±2.8)周。25例患者伤口均一期愈合,随访期间无切口感染、内固定物松动及断裂等并发症发生。术后骨折复位质量根据Matta评分标准评定:优16例,良6例,可2例,差1例,优良率为88%。末次随访时根据Majeed评分系统评定骨盆功能:优9例,良12例,可4例,优良率为84%。结论:骨盆前环入口位结合闭孔出口位透视是一种简单、易行的术中透视技术,可清晰识别耻骨支前后界限,有效避免螺钉突破骨皮质,缩短手术时间,减少透视次数,提高前环耻骨支螺钉置入的精确性和安全性,是对骨盆透视方法的有益补充。

Objective:To investigate the clinical significance of pubic ramus screw placement assisted by obturator outlet fluoroscopy at the anterior ring entrance of the pelvis.Methods:Twenty-five patients with pelvic fractures admitted from January 2020 to January 2021 were enrolled in this retrospective study including 14 males and 11 females,with the mean age of(41.3±11.6)years(range,22-73 years).All patients were measured the perspective angle of the pelvic anterior ring entrance position on CT before surgery.During the operation,C-arm fluoroscopy of anterior pelvic ring inlet combined with obturator outlet fluoroscopy were used to assist the placement of the pubic ramus channel screw in the anterior pelvic ring,and the position of the pubic ramus screw was verified by CT after surgery.Results:A total of 32 screws were implanted in 25 patients including 20 retrograde pubic ramus screws and 12 anterograde pubic ramus screws.The mean placement time of each screw was(21.9±1.5)min(range,20-32 min).The preoperative average angle of anterior pelvic ring entrance was 35.38°±3.63°(range,31.2°-38.9°),and there was no statistical difference between male and female patients(P>0.05).All patients had primary wound healing,and no complications such as incision infection,and loosening and fracture of internal fixation occurred during the follow-up period.The quality of postoperative fracture reduction was assessed according to Matta scoring standard:excellent in 16 patients,good in 6 patients,acceptable in 2 patients and poor in 1 patient,with an excellent and good rate of 88%.Twenty-five patients were followed up for 7-12 months,with an average time of(8.5±1.2)months.The healing time of fractures was between 16 and 24 weeks,with an average time of(18.0±2.8)weeks.At the last follow-up,the pelvic function was assessed by Majeed scoring system:excellent in 9 patients,good in 12 patients and acceptable in 4 patients,with an excellent and good rate of 84%.All the pubic ramus screws were located in the anterior annular bone channel,and no screw dislocation or breakthrough occurred in the anterior and posterior bone cortex.Conclusions:Anterior ring entrance of pelvis fluoroscopy is a simple and feasible intraoperative fluoroscopy technique,which is a good supplement to pelvic fluoroscopy.It can clearly identify the anterior and posterior boundaries of the pubic ramus,effectively avoid the screw breaking through the bone cortex,effectively shorten the operation time,reduce the number of fluoroscopy,and improve the accuracy and safety of anterior ring pubic ramus screw placement.