骨盆解锁复位架联合智能可视化系统辅助复位与固定治疗Tile C1型骨盆骨折

Pelvic unlocking closed reduction technique combined with HoloSight system in reducing and fixating Tile C1 pelvic fractures

目的探讨骨盆解锁复位架联合智能可视化系统(HoloSight)辅助复位与固定治疗Tile C1型骨盆骨折的疗效。方法回顾性分析2019年3月至2022年9月华中科技大学同济医学院附属同济医院创伤外科治疗的Tile C1型骨盆骨折患者26例, 其中13例采用骨盆解锁复位架联合HoloSight智能可视化系统辅助复位与置钉(HoloSight辅助置钉组), 13例采用骨盆解锁复位架复位徒手置钉(徒手置钉组)。HoloSight辅助置钉组男7例、女6例, 年龄(46.85±15.63)岁, 骨盆骨折Tile分型C1.1型2例、C1.2型2例、C1.3型9例, 体质指数为(24.08±4.15) kg/m2, 术前垂直移位(1.80±0.76) cm, 向后移位(0.80±0.63) cm。徒手置钉组男9例、女4例, 年龄(38.38±13.82)岁, 骨盆骨折Tile分型C1.1型3例、C1.2型4例、C1.3型6例, 体质指数为(22.85±3.54) kg/m2, 术前垂直移位(1.77±0.70) cm, 向后移位(1.17±0.58) cm。记录患者的骨折复位时间、手术前后骨折移位、单枚螺钉固定时间、术中复位和固定透视次数、视觉模拟评分(visual analogue scale, VAS)、Matta复位质量评价、Majeed评分和并发症发生情况。结果所有患者均获得随访, 随访时间(13.65±5.06)个月。HoloSight辅助置钉组复位时间[(39.77±11.22) min]、单枚螺钉置入时间[(10.72±2.12) min]和固定总时间[(37.15±12.12) min]较徒手置钉组[分别为(67.46±16.67) min、(18.38±3.62) min和(58.31±7.66) min]用时短(t=4.97, 6.59, 5.32), 复位透视次数[(4.38±1.33)次]和固定透视次数[(14.00±5.79)次], 较徒手置钉组[(50.69±12.48)次和(47.77±19.34)次]少(t=13.30, 6.03), 差异均有统计学意义(P<0.05)。所有患者骨盆骨折均愈合, HoloSight辅助置钉组骨折愈合时间为(4.92±1.66)个月, 徒手置钉组为(5.23±1.69)个月, 差异无统计学意义(t=0.47, P=0.644)。术后Matta标准评估, HoloSight辅助置钉组13例患者, 优9例、良4例, 优良率为100%;徒手置钉组13例, 优9例、良4例, 优良率为100%。HoloSight辅助置钉组术前VAS评分为(6.08±1.32)分, 徒手置钉组为(5.69±1.49)分, 两组差异无统计学意义(t=0.70, P=0.493)。HoloSight辅助置钉组术后VAS评分为(2.08±1.04)分, 徒手置钉组为(2.62±1.45)分, 两组差异无统计学意义(t=1.09, P=0.286);两组VAS改善程度的差异无统计学意义(t=1.15, P=0.262)。术后6个月HoloSight辅助置钉组Majeed评分为(91.23±7.18)分、徒手置钉组为(86.38±9.98)分, 差异无统计学意义(t=1.42, P=0.168)。结论 HoloSight联合骨盆解锁复位架辅助复位与固定治疗Tile C1型骨盆骨折, 可有效降低骨折的复位和固定难度, 缩短复位和固定时间, 减少对患者和医生的透视辐射。

Objective To explore the effectiveness of unlocking closed reduction technique(UCRT)combined with the"Transparent Orthopaedics"intelligent visualization system(HoloSight)in reducing and fixating Tile C1 type pelvic fractures.Methods Data of 26 patients with Tile C1 pelvic fracture treated by trauma surgery in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from March 2019 to September 2022 were retrospectively analyzed.Among them,13 patients were treated with the UCRT combined with the HoloSight system(HoloSight group),and 13 patients were treated with the UCRT(control group).There were 7 men and 6 women in the HoloSight group,with a mean age of 46.85±15.63 years.The pelvic fractures were classified as C1.1 in 2 cases,C1.2 in 2 cases,and C1.3 in 9 cases.The mean body mass index(BMI)was 24.08±4.15 kg/m2.The preoperative vertical displacement was 1.80±0.76 cm and the posterior displacement was 0.80±0.63 cm.There were 9 men and 4 women in the control group,with a mean age of 38.38±13.82 years.The pelvic fractures were classified as C1.1 in 3 cases,C1.2 in 4 cases,and C1.3 in 6 cases.The mean BMI was 22.85±3.54 kg/m2.The preoperative vertical displacement was 1.77±0.70 cm and the posterior displacement was 1.17±0.58 cm.The fracture reduction time,preoperative and postoperative fracture displacement,single screw fixation time,intraoperative reduction and fixation fluoroscopy times,visual analogue scale(VAS),Matta scoring,Majeed's score,and complications were recorded for each patient.Results All patients were followed up for 13.65±5.06 months.The reduction time in the HoloSight group was 39.77±11.22 minutes,the single screw fixation time was 10.72±2.12 minutes,and the total fixation time was 37.15±12.12 minutes,which were significantly shorter than those in the control group,which were 67.46±16.67 minutes,18.38±3.62 minutes,and 58.31±7.66 minutes,respectively(t=4.97,6.59,5.32).The reduction and fixation fluoroscopy times were 4.38±1.33 times and 14.00±5.79 times in the HoloSight group,which were significantly less than those in the control group,which were 50.69±12.48 times and 47.77±19.34 times(t=13.30,6.03).The differences were statistically significant(P<0.05).All patients'pelvic fractures healed with no significant difference(t=0.47,P=0.644)in fracture healing time between the HoloSight group(4.92±1.66 months)and the control group(5.23±1.69 months).Postoperative Matta scoring showed that 13 patients in the HoloSight group were rated as excellent,4 patients were rated as good,and the excellent and good rate was 100%.In the control group,13 patients were rated as excellent and 4 patients were rated as good,with an excellent and good rate of 100%.There was no significant difference(t=0.70,P=0.493)in preoperative VAS between the HoloSight group(6.08±1.32)and the control group(5.69±1.49).There was no significant difference(t=1.09,P=0.286)in postoperative VAS between the HoloSight group(2.08±1.04)and the control group(2.62±1.45),and there was no significant difference in VAS improvement between the two groups(t=1.15,P=0.262).There was no significant difference(t=1.42,P=0.168)in Majeed's score at 6 months postoperatively between the HoloSight group(91.23±7.18)and the control group(86.38±9.98).Conclusion HoloSight system combined with UCRT frame can effectively reduce the difficulty of fracture reduction and fixation,shorten the time of fracture reduction and fixation,and reduce the radiation to patients and doctors in the treatment of pelvic fractures.