导航下经皮空心螺钉内治疗DayⅡ型骨盆新月形骨折脱位
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中国人民解放军中部战区总医院

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卫勤保障能力创新与生成专项(20WQ034);2021年度湖北省卫健委首届转化医学(WJ2021ZH0010)


The percutaneous cannulated screws in the treatment of Day typeⅡcrescent fracture of pelvis under navigation
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Department of Orthopedics, General Hospital of Central Theater Command of PLA

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    摘要:

    目的 介绍导航下经皮空心螺钉治疗DayⅡ型CFDP的手术技术和初步临床效果。方法 2015年1月?2021年12月采用23例DayⅡ型CFDP患者采用上述手术方法治疗。术前采用Mimics 17.0 软件规划螺钉固定方式。术中采用骨科3D导航,安装示踪器后以患侧骶髂关节为中心完成导航的注册,获得新月形骨折线通过骶髂关节的相对位置。先导航下骶髂螺钉于新月形骨折前方固定骶髂关节,后于导航“泪滴”位下置入LC-Ⅱ螺钉。再以CLIC点为进针点与LC-Ⅱ螺钉平行或(呈“八”字)钻入第二枚螺钉。结果 23例患者顺利完成手术,无神经血管损伤等并发症。LC-Ⅱ螺钉置入时间平均为(2.32?0.34)min。根据Gras分类,螺钉安全置钉率为95.6%(22/23);根据Matta影像学标准,其优良率为91.3%(21/23);术后6个月Majeed功能评分较术前明显改善(P<0. 01)。1枚骶髂螺钉出现螺钉松动,1枚髂骨后螺钉穿出骨内侧皮质。结论 导航下经皮空心螺钉治疗DayⅡ型CFDP具有放射损害低、置钉精准、骨折复位满意及功能恢复良好等优点。

    Abstract:

    Objective To introduce the surgical technique and preliminary clinical results of percutaneous cannulated screws in the treatment of Day typeⅡcrescent fracture dislocation of pelvis under navigation. Methods From January 2015 to December 2018, 23 patients with Day typeⅡcrescent fracture dislocation of pelvis were treated with the above surgical methods. Mimics 17.0 software was used to plan screws fixation before operation. Orthopedic 3D navigation was used during the operation. After the tracker was installed, the registration of navigation was completed centering on the sacroiliac joint on the affected side to obtain the relative position of the crescent fracture line passing through the sacroiliac joint. Under navigation, sacroiliac screws were used to fix the sacroiliac joint in front of the crescent fracture, and then LC-Ⅱ screws were placed under the navigation "teardrop" position. Then use the CLIC point as the needle entry point to drill in the second screw parallel or (in the shape of "eight") to the LC-Ⅱ screw. Results Twenty-three patients successfully completed the operation without complications such as neurovascular injury. The time of LC-II screw placement was 1.8~3.0 min with an average of (2.32?0.34)min. The screw positions were assessed by Gras classification, with a safe screws placement rate of 95.6%(22/23. According to the Matta imaging criteria, the excellent and good rate was 91.3%(21/23). The Majeed functional score at 6 months after operation was significantly improved compared with that before operation (P<0. 01). One sacroiliac screw loosened, and one posterior iliac screw penetrated the medial cortex of the bone. Conclusion The percutaneous cannulated screws in the treatment of Day typeⅡcrescent fracture dislocation of pelvis under navigation has the advantages of low radiation exposure, high accuracy of screw placement, satisfactory anatomical reduction, good functional recovery.

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  • 收稿日期:2022-06-29
  • 最后修改日期:2023-02-16
  • 录用日期:2023-04-11
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