摘要
目的对比分析三维数字规划结合导航与单纯导航下经皮骶髂关节螺钉内固定治疗骶髂关节复合体（SIJC）损伤的临床疗效。方法采用回顾性病例对照研究分析2015年1月-2017年5月收治的49例SIJC损伤患者临床资料，其中男27例，女22例；年龄21～66岁，平均39．3岁。骨折按AO分型：B1型10例，B2型19例，C1型20例。受伤至手术时间5～11d，平均6．5d。根据术前是否应用三维数字规划分为三维数字规划结合导航组（A组，24例）和单纯导航组（B组，25例）。A组在术前应用Mimics计算机外科辅助软件在健侧骶髂关节模拟手术置入骶髂关节螺钉，B组不行术前模拟规划。比较两组骶髂关节螺钉置入时间、透视次数、术中出血量；采用改良Matta标准评分评定骨折复位质量；末次随访髋关节功能评定采用Majeed功能评分；观察骨折愈合及并发症情况等。结果49例患者均获随访6～24个月，平均10．4个月。A组置钉时间为（18．4±3．0）min，B组为（26．4±3．8）min；A组透视次数为（12．9±3．8）次，B组为（19．4±1．5）次（P均〈0．05）。A组和B组术中出血量分别为（14．1±3．0）ml、（15．1±2．2）ml（P〉0．05）。骨折复位质量按改良Matta标准评分：A组优良率为92％（22／24），B组为92％（23／25）；末次随访时Majeed功能评分：A组优良率为96％（23／24），B组为92％（23／25）（P均〉0．05）。两组患者术后4个月复查均获骨性愈合，无切口感染、下肢深静脉血栓形成、螺钉松动等并发症。结论术前三维数字规划可减少导航下经皮骶髂关节螺钉置人的时间及术中透视次数，是导航下经皮骶髂关节螺钉内固定术的一种有效辅助手段。
Objective To compare the clinical effect of digital orthopedic three-dimensional visualization technology combined with image-based computer navigation and simple image-based computer navigation in percutaneous screw fixation for the treatment of sacroiliac joint complex injury. Methods A retrospective case-control analysis was conducted on 49 cases of sacroiliac complex injury from January 2015 to May 2017. There were 27 males and 22 females, with an average of 39.3 years old （range, 21-66 years）. According to AO typing, there were 10 cases of type B1, 19 type B2, and 20 type C1. The duration from injury to operation ranged from 5 to 11 days （ mean, 6.5 days）. Based on the application of three-dimensiona digital programming, the 49 cases were assigned to Group A （ n = 24 ） which used Mimics computer assisted surgery software to simulate screw placement on the healthy side of sacroilic joint before operation and Group B （ n =25 ） without the simulation programming. Screw placement time, intraoperative fluoroscopy frequency, and intraoperative bleeding were compared between two groups. Fracture reduction was evaluated by modified Matta standard score, and the function of hip joint by Majeed pelvic fracture function score at the last follow-up. Fracture healing and complications were observed. Results All patients were followed up for an average of 10.4 months （range, 6-24 months）. The time of sacroiliac joint screw placement [ （18. 4 ± 3.0）mini and the intraoperative fluoroscopy frequency [ （12.9 ± 3.8 ）times] in Group A were significantly less than those [ （26. 4 ± 3.8） min, （19.4 ± 1.5 ） times] in Group B （P 〈 0.05 ）. There were no significant differences between Group A and Group B in intraoperative bleeding [ （ 14.1 ± 3. 0） ml vs. （ 15.1 ± 2.2 ） ml ] （ P 〉 0. 05 ）. According to the modified Matta reduction standard, the good and excellent rate of Group A was 92% （22/24）, and that of Group B was 92% （23/25）. At the last follow up, the Majeed
作者
陈龙
宋虎
蔡贤华
汪国栋
刘曦明
Chen Long;Song Hu;Cai Xianhua;Wang Guodong;Liu Ximing.(Department of Orthopedics, Wuhan General Hospital of People＇s Liberation Army, Clinical Medical Research Center of Bone Trauma Treatment in Hubei Province, Wuhan 430070, Chin)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2018年第6期490-496,共7页
Chinese Journal of Trauma
基金
湖北省技术创新重大项目（2017ACA099）
湖北省卫计委一般项目（WJ2018H0064）
关键词
骶髂关节
成像
三维
外科手术
计算机辅助
骨钉
Sacroiliac joint
Imaging
three-dimensional
Surgery
computer-assisted
Bone nail
