智能可视化系统辅助经皮骶髂螺钉内固定治疗Tile C1型骨盆骨折

3D navigation-assisted percutaneous sacroiliac screw fixation for Tile C1 pelvic fractures

目的分析智能可视化系统辅助经皮骶髂螺钉内固定治疗Tile C1型骨盆骨折的临床疗效。方法回顾性分析2019年9月至2022年3月于柳州市人民医院接受智能可视化系统导航辅助经皮骶髂螺钉内固定治疗的Tile C1型骨盆患者12例(可视化组), 男8例、女4例, 年龄(43.08±16.93)岁(范围21~72岁)。按照1∶2的比例根据年龄和性别进行配对, 选择同期接受透视辅助下经皮骶髂螺钉内固定治疗的Tile C1型骨盆骨折患者24例(透视辅助组)作为对照。男15例、女9例, 年龄(45.75±11.69)岁(范围32~75岁)。比较两组患者的手术时间、术中出血量、螺钉置入数量、术中透视次数、导针钻孔次数及Majeed骨盆功能评分。基于Matta评分标准评价骨盆骨折复位质量, 根据Lonstein评价标准计算螺钉切出率, 采用Brooker分级评价术后异位骨化程度。结果所有患者均获得随访, 随访时间(18.1±4.7)个月(范围12~30个月)。可视化组手术时间为(110.67±44.85) min、术中透视次数为(24.42±9.94)次、导针钻孔次数为(7.33±4.70)次, 低于透视辅助组的(145.00±48.51) min、(75.75±29.47)次、(13.92±5.78)次, 差异均有统计学意义(P<0.05)。末次随访时, 可视化组Majeed骨盆功能评分为(89.08±3.89)分, 优良率为100%(12/12);透视辅助组为(74.00±10.71)分, 优良率为79%(19/24), 差异有统计学意义(χ2=10.23, P<0.001)。可视化组Matta分级优良率为92%(11/12), 透视辅助组为79%(19/24), 差异无统计学意(χ2=2.93, P=0.403)。可视化组螺钉切出率为17%(2/12)、异位骨化率为8%(1/12), 低于透视辅助组的71%(17/24)和13%(3/24), 差异均有统计学意义(χ2=9.76, P=0.021;χ2=31.71, P<0.001)。结论智能可视化系统辅助经皮骶髂螺钉内固定治疗Tile C1骨盆骨折可减少手术时间和辐射暴露, 术后骨盆功能恢复好, 螺钉切出率和异位骨化发生率降低。

Objective To analyze the clinical efficacy of three-dimensional(3D)navigation-assisted percutaneous sacroiliac screw fixation in the treatment of Tile C1 pelvic fractures.Methods A total of 12 patients with Tile C1 pelvic fractures who underwent percutaneous sacroiliac screw fixation assisted by 3D navigation in Liuzhou People's Hospital Affiliated to Guangxi Medical University from September 2019 to March 2022 were retrospectively analyzed.There were 8 males and 4 females,aged 43.08±16.93 years(range,21-72 years).24 patients with Tile C1 pelvic fractures who underwent fluoroscopy-assisted percutaneous sacroiliac screw internal fixation during the same period were selected as controls by pairing them according to age and sex in a ratio of 1:2.There were 15 males and 9 females,aged 45.75±11.69 years(range,32-75 years).The operation time,intraoperative blood loss,number of screws,intraoperative fluoroscopy times,guide pin drilling times and pelvic function scores were compared between the two groups.The quality of pelvic fracture reduction was evaluated based on the Matta scoring criteria,the screw cut-out rate was calculated according to the Lonstein evaluation criteria,and the degree of postoperative heterotopic ossification was evaluated according to the Brooker grading system.Results All patients were followed up for 18.1±4.7 months(range,12-30 months).In the 3D navigation group,the operation time was 110.67±44.85 min,the number of intraoperative fluoroscopies was 24.42±9.94,and the number of guided needle drilling was 7.33±4.70,which was lower than 145.00±48.51 min,75.75±29.47,and 13.92±5.78 in the fluoroscopically-assisted group,and the differences were statistically significant(P<0.05).At the last follow-up,the Majeed pelvic function score of 3D navigation group was 89.08±3.89,and the excellent and good rate was 100%(12/12).The score of fluoroscopy-assisted group was 74.00±10.71,and the excellent and good rate was 79%(19/24).The difference was statistically significant(χ2=10.23,P<0.001).The excellent and good rate of Matta grading was 92%(11/12)in the 3D navigation group and 79%(19/24)in the fluoroscopic assisted group,showing no significant difference between the two groups(χ2=2.93,P=0.403).The screw cut-out rate and heterotopic ossification rate in the 3D navigation group were 17%(2/12)and 8%(1/12),which were lower than 71%(17/24)and 13%(3/24)in the fluoroscopy-assisted group,and the differences were statistically significant(χ2=9.76,P=0.021;χ2=31.71,P<0.001).Conclusion 3D navigation-assisted percutaneous sacroiliac screw fixation for Tile C1 pelvic fractures can reduce the operation time and radiation exposure,improve the postoperative pelvic function,and reduce the incidence of screw cut-out and heterotopic ossification.