摘要
目的探讨X线透视和CT引导两种影像学监测方式进行经皮骶髂关节螺钉固定治疗Tile B、C型骨盆骨折或脱位的应用效果。方法采用回顾性病例对照研究分析2007年1月—2017年12月北部战区总医院收治的103例Tile B、C型骨盆后环骨折或脱位患者临床资料,其中男58例,女45例;年龄28~69岁,平均43.8岁。84例骶骨正常,19例存在骶骨变异。分别比较两种不同骶骨类型患者术后2 d X线透视(正常骶骨置钉46例,变异骶骨置钉11例)或CT引导(正常骶骨置钉66例,变异骶骨置钉18例)置入骶髂螺钉的准确率、置钉时间,采用Matta标准对术后9个月疗效分别进行影像学愈合和临床预后评估。结果对于正常骶骨,术后2 d X线透视下螺钉置入准确率[89%(41/46)]与CT引导[94%(62/66)]比较差异无统计学意义(P>0.05);而对于变异骶骨,术后2 d CT引导的准确率[89%(17/18)]显著高于X线透视[55%(6/11)](P<0.05)。对于正常骶骨,X线透视下置钉时间[(39.1±4.9)min]显著短于CT引导[(54.7±3.8)min](P<0.05);而对于变异骶骨,两种方式置钉时间差异无统计学意义(P>0.05)。术后9个月时,对于正常骶骨,X线透视的影像学愈合优良率[100%,其中优秀74%(34/46),良好26%(12/46)]及临床预后优良率[100%,其中优秀83%(38/46),良好17%(8/46)]与CT引导[100%,其中优秀83%(55/66),良好17%(11/66);100%,其中优秀92%(61/66),良好8%(5/66)]比较差异均无统计学意义(P>0.05)。对于变异骶骨,术后9个月X线透视的影像学愈合优良率[73%,其中优秀9%(1/11),良好64%(7/11)]显著低于CT引导[95%,其中优秀56%(10/18),良好39%(7/18)](P<0.05),而临床预后优良率[91%,其中优秀55%(6/11),良好36%(4/11)]与CT引导[100%,其中优秀78%(14/18),良好22%(4/18)]比较差异无统计学意义(P>0.05)。结论对于正常骶骨的Tile B、C型骨盆后环骨折或脱位,X线透视置钉准确率、影像学愈合优良率和临床预后优良率与CT引导相同,但置钉时间更短。对于变异骶骨,
Objective To investigate the effect of X-ray fluoroscopy and CT guided technique in sacroiliac screw fixation for type Tile B or C sacrum pelvic fractures or dislocations.Methods A retrospective case control study was conducted to analyze the clinical data of 103 patients with type Tile B or C posterior pelvic ring fracture or dislocation admitted to the General Hospital from Northern Theater of PLA from January 2007 to December 2017.There were 58 males and 45 females,aged 28-69 years,with an average age of 43.8 years.Among the patients,84 had normal sacrums while 19 had dysmorphic sacrums.The accuracy and placement time of two kinds of sacroiliac screw were compared by X-ray fluoroscopy(46 patients with normal sacroiliac screw placement and 11 with dysmorphic sacroiliac screw placement)or CT guidance(66 patients with normal sacroiliac screw placement and 18 with dysmorphic sacroiliac screw placement)were compared.Matta standard was used to evaluate the imageological healing and clinical prognosis 9 months after operation.Results In normal sacrum group,there was no statistical difference in placement accuracy between X-ray fluoroscopy[89%(41/46)]and CT guided technique[94%(62/66)](P>0.05).In dysmorphic sacrum group,the placement accuracy of CT guided technique[89%(17/18)]was significantly higher than that of X-ray fluoroscopy[55%(6/11)](P<0.05).The screw placement time of X-ray fluoroscopy[(39.1±4.9)minutes]was significantly shorter than that of CT guided technique(54.7±3.8)minutes for normal sacrums(P<0.05),and there was no significant difference in terms of placement time by CT guided technique for dysmorphic sacrums(P>0.05).Nine months after operation,in normal sacrum group,the X-ray fluoroscopy had the excellent rate of 74%(34/46),good rate of 26%(12/46)for healing and the excellent rate of 83%(38/46),good rate of 17%(8/46)for clinical prognosis,showing no significant difference from those of CT guided technique[83%(55/66),17%(11/66);92%(61/66),8%(5/66)](P>0.05).In dysmorphic sacrum group 9 months after ope
作者
马翔宇
刘兵
刘欣伟
薛海鹏
杨超
周大鹏
Ma Xiangyu;Liu Bing;Liu Xinwei;Xue Haipeng;Yang Chao;Zhou Dapeng(Department of Orthopedics,General Hospital of Northern Theater of PLA,Shenyang 110016,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2019年第12期1101-1108,共8页
Chinese Journal of Trauma
关键词
骨盆
脱位
骶骨
骨折固定术
内
Pelvis
Dislocations
Sacrum
Fracture fixation,internal
