3种骶2髂骨螺钉置钉技术准确性的比较研究

Comparison of accuracy of three kinds of second sacral alar iliac screw placement techniques

目的:比较传统徒手置钉,3D打印模板引导技术(three-dimensional printed template guided technique,TGT)和ball tip置钉技术在置入骶2髂骨(s2 alar-iliac,S2AI)螺钉的准确性。方法:回顾分析接受S2AI螺钉放置的145例患者,按置钉技术不同将其分为徒手技术组(36例)、TGT技术组(48例)和ball tip技术组(61例)。所有患者术前行骨盆CT确认最佳S2AI螺钉的最佳轨道参数,术后CT扫描评估螺钉轨迹的准确性,比较3种技术的置钉准确性。结果:3组患者S2AI螺钉的最佳轨道参数差异均无统计学意义(P>0.05);3组患者共置入S2AI螺钉290枚。其中,传统徒手技术组72枚,TGT技术组96枚,ball tip技术组122枚。传统徒手组置钉不准确率为18.1%(13/72),TGT技术组置钉不准确率3.1%(3/96),ball tip组置钉不准确率为4.1%(5/122):TGT技术组置钉准确性高于传统徒手技术组,差异有统计学意义(P<0.05);ball tip技术组置钉准确性也高于传统徒手技术组,差异有统计学意义(P<0.05);TGT技术组置钉准确性虽高于ball tip技术组,但差异无统计学意义(P>0.05)。结论:TGT技术和ball tip技术均为S2AI螺钉置入的可靠技术,二者的准确性均明显高于徒手技术,但ball tip技术操作简单。

Objective:To compare the accuracy of the conventional freehand technique,three-dimensional printed template-guided technique(TGT),and ball tip technique for second sacral alar iliac(S2AI)screw placement.Methods:One hundred and forty-five pa⁃tients who underwent S2AI screw placement were retrospectively reviewed.According to the screw placement techniques,they were di⁃vided into freehand technique group(36 cases),TGT group(48 cases),and ball tip technique group(61 cases).All the patients under⁃went computed tomography before operation to identify the parameters of the optimal trajectory of S2AI screws and also after operation to assess the accuracy of the screw trajectory.The accuracy of screw insertion with the three techniques was compared.Results:There were no significant differences in the optimal trajectory parameters of S2AI screws between the three groups(P>0.05).A total of 290 S2AI screws were placed,with 72 in the conventional freehand technique group,96 in the TGT group,and 122 in the ball tip technique group.The inaccuracy rate of screw placement was 18.1%(13/72)for the freehand group,3.1%(3/96)for the TGT group,and 4.1%(5/122)for the ball tip group.The accuracy of the TGT group was significantly higher than that of the freehand group(P<0.05).The accu⁃racy of the ball tip group was also significantly higher than that of the freehand group(P<0.05).The accuracy of screw placement was higher in the TGT group than in the ball tip group,but the difference was not statistically significant(P>0.05).Conclusion:The TGT technique and ball tip technique are reliable approaches to S2AI screw placement,both with significantly higher accuracy compared with the freehand technique,and in addition,the ball tip technique is easier to perform compared with the other two techniques.