骨盆骨折通道螺钉导向系统的设计及其辅助置入导针的准确性研究

Study on the needle placement accuracy assisted by self-designed channel screw guide system for pelvic fractures

目的:探讨自行研制的骨盆骨折通道螺钉导向系统在体外骨盆模型中辅助置入导针的准确性。方法:选取60具骨盆模型,按照随机数字表随机分为两组( n=30):实验组利用自行研制的环骨盆骨折通道螺钉导向系统及相应的模拟手术步骤,在透视引导下将2.0 mm克氏针置入骨盆模型的骶髂通道;对照组在C型臂X线机引导下徒手置入骶髂关节螺钉导针。术后通过肉眼观察、骨盆入口位及出口位X线片透视测量导针在骶骨中线位置距离此处骨通道中心点的偏移距离来评估导针位置,比较两组导针的偏移距离、手术操作时间、透视次数及导针调整次数等。 结果:实验组所有骨盆模型均顺利置入导针,无一枚导针穿出模型通道外,对照组有3枚导针穿出模型通道外。X线片测量结果显示:实验组骨盆模型导针的偏移距离为(2.23±0.82)mm,显著小于对照组骨盆模型[(4.46±2.28)mm];透视次数为(12.0±0.3)次,导针调整次数为(8.0±0.3)次,显著少于对照组骨盆模型[(26.0±0.4)、(24.0±0.8)次];手术操作时间为(0.52±0.25)h,显著短于对照组骨盆模型[(1.26±0.36)h],以上项目两组之间比较差异均有统计学意义( P<0.05)。以直径2 mm为可接受范围,其精准率高达95.5%。 结论:与徒手置入导针相比,骨盆骨折通道螺钉导向系统能更准确置入导针,减少透视次数和导针调整次数,缩短手术操作时间。

ObjectiveTo investigate the needle placement accuracy assisted by our self-designed channel screw guide system for pelvic fractures.MethodsSixty pelvic models(provided by Shandong Weigao Group)were randomized into 2 groups(n=30).In the experimental group,2.0 mm Kirkler needles were implanted into the sacroiliac channel using our self-developed channel needle guide system in corresponding simulated surgical procedures;in the control group,the guide needles for sacroiliac screws were implanted manually under the guidance of C-arm fluoroscopy.The needle positions were assessed by gross observation and the offset distances measured on the X-ray films of pelvic entrance and exit views between the guide needle at the midline of the sacrum and the center point of bone channel.The offset distance,operation time,fluoroscopy frequency,and needle adjustment frequency were compared between the 2 groups of guide needles.ResultsGuide needles were successfully implanted in all the pelvic models in the experimental group,with no penetration of guide needles outside the model.In the control group,3 guide needles penetrated outside the model channel.The X-ray measurements showed that the offset distance of the needle in the experimental group was(2.23±0.82)mm,significantly smaller than that in the control group[(4.46±2.28)mm](P<0.05).In the experimental group,the fluoroscopy frequency[(12.0±0.3)times]and the needle adjustment frequency[(8.0±0.3)times]were significantly less than those in the control group[(26.0±0.4)times and(24.0±0.8)times](P<0.05).The operation time was(0.52±0.25)hours in the experimental group,significantly shorter than that in the control group[(1.26±0.36)hours](P<0.05).With a 2 mm diameter as an acceptable range,the accuracy was as high as 95.5%.ConclusionCompared with manual placement of guide needles,our self-designed pelvic fracture channel screw guide system can lead to more accurate needle placement,reduced fluoroscopy frequency,fewer guide needle adjustments,and shortened operation time.