术中滑轨CT辅助在经皮骶髂关节螺钉治疗骨盆后环损伤中的应用
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作者Author单位AddressE-Mail
盛斌 SHENG Bin 湖南省人民医院 湖南师范大学附属第一医院骨七科, 湖南 长沙 410000 The 7th Department of Orthopaedics, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha 410000, Hunan, China shengbin2009@163.com 
王奕威 WANG Yi-wei 湖南省人民医院 湖南师范大学附属第一医院骨七科, 湖南 长沙 410000 The 7th Department of Orthopaedics, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha 410000, Hunan, China  
王愉思 WANG Yu-si 湖南省人民医院 湖南师范大学附属第一医院骨七科, 湖南 长沙 410000 The 7th Department of Orthopaedics, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha 410000, Hunan, China  
刘德龙 LIU De-long 湖南省人民医院 湖南师范大学附属第一医院骨七科, 湖南 长沙 410000 The 7th Department of Orthopaedics, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha 410000, Hunan, China  
杨瞻宇 YANG Zhan-yu 湖南省人民医院 湖南师范大学附属第一医院骨七科, 湖南 长沙 410000 The 7th Department of Orthopaedics, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha 410000, Hunan, China  
关蕊 GUAN Rui 湖南省人民医院 湖南师范大学附属第一医院骨七科, 湖南 长沙 410000 The 7th Department of Orthopaedics, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha 410000, Hunan, China  
刘超 LIU Chao 湖南省人民医院 湖南师范大学附属第一医院骨七科, 湖南 长沙 410000 The 7th Department of Orthopaedics, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha 410000, Hunan, China  
期刊信息:《中国骨伤》2024年,第37卷,第5期,第438-444页
DOI:10.12200/j.issn.1003-0034.20220787
基金项目:
中文摘要:

目的:比较术中滑轨CT联合C形臂X线机辅助与单纯使用C形臂X线机辅助透视下经皮骶髂关节螺钉治疗骨盆后环损伤临床疗效。

方法:自2018年12月至2022年2月收治76例骨盆后环损伤患者,其中,C形臂联合滑轨CT辅助下行内固定治疗39例为CT组,男23例,女16例,年龄(44.98±7.33)岁;仅在C形臂透视下行内固定治疗37例为C形臂组,男24例,女13例,年龄(44.37±10.82)岁。合并有前环骨折患者42例,均采用经皮髂前下棘内置外固定架(internal fixation,INFIX)或耻骨上支螺钉固定骨盆前环。术后比较两组随访时间、置钉时间、并发症。比较两组Matta复位评价、Majeed疗效评价、CT分级及二次手术翻修率。

结果:CT组置钉时间(32.63±7.33) min,短于C形臂组(52.95±10.64) min(t=-9.739,P<0.05)。CT组随访时间(11.97±1.86)个月,C形臂组(12.03±1.71)个月,两组比较差异无统计学意义(P>0.05)。两组术后并发症发生比较,差异无统计学意义(χ2=0.159,P>0.05)。CT组Matta复位评价结果(Z=2.79,P<0.05)、Majeed疗效评价结果(Z=2.79,P<0.05)、CT分级(Z=2.83,P<0.05)均优于C形臂组。CT组二次手术翻修率低于C形臂组(χ2=5.641,P<0.05)。

结论:术中滑轨CT联合C形臂辅助下经皮骶髂关节螺钉置入手术与传统C形臂透视相比,具有手术时间短、准确度及安全性高、术后二次翻修率显著下降等特点,是重建骨盆骨折后环稳定性的有效方法之一。
【关键词】滑轨CT  经皮骶髂关节螺钉  骨盆后环损伤  术中透视  微创
 
Intraoperative slide rail CT assistance in percutaneous sacroiliac joint screws for the treatment of pelvic posterior ring injury
ABSTRACT  

Objective To compare the clinical efficacy of intraoperative slide rail CT combined with C-arm X-ray assistance and just C-arm for percutaneous screw in the treatment of pelvic posterior ring injury.

Methods A retrospective analysis was performed on the patient data of 76 patients with posterior pelvic ring injury admitted to the Department of Orthopedic Trauma from December 2018 to February 2022. Among them,39 patients in the CT group were treated with C-arm combined with slide rail CT-assisted inline fixation including 23 males and 16 females with an average age of (44.98±7.33) years old;and the other 37 patients in the C-arm group were treated with intraline fixation treatment under only C-arm fluoroscopy including 24 males and 13 females with an average age of (44.37±10.82) years old. Among them,42 patients with anterior ring fractures were treated with percutaneous inferior iliac spines with internal fixation (INFIX) or suprapubic support screws to fix the anterior pelvic ring. Postoperative follow-up time,operation time,complications of the two groups were compared.

Results of Matta reduction criteria,Majed efficacy evaluation,the CT grading and the rate of secondary surgical revision were compared. Results The nailing time of (32.63±7.33) min in CT group was shorter than that of (52.95±10.64) min in C-arm group (t=-9.739,P<0.05). The follow-up time between CT group (11.97±1.86) months and C-arm group (12.03±1.71) months were not statistically significant(P>0.05). The postoperative complication rates between two groups were not statistically significant (χ2=0.159,P>0.05). Results of Matta reduction criteria (Z=2.79,P<0.05),Majeed efficacy evaluation(Z=2.79,P<0.05),CT grading (Z=2.83,P<0.05) in CT group were better than those in C-arm group(P<0.05); the secondary surgical revision rate in the CT group was significantly lower than that in the C-arm group (χ2=5.641,P<0.05)..

Conclusion Compared with traditional C-arm fluoroscopy,intraoperative slide rail CT combined with C-arm assisted percutaneous sacroiliac joint screw placement surgery has the characteristics of short operation time,high accuracy and safety,and significant decrease in postoperative secondary revision rate,and is one of the effective methods for re-establishing the stability of the posterior ring of pelvic fracture.
KEY WORDS  Slide rail CT  Percutaneous sacroiliac joint screws  Pelvic posterior ring injury  Intraoperative fluoroscopy  Minimally invasive
 
引用本文,请按以下格式著录参考文献:
中文格式:盛斌,王奕威,王愉思,刘德龙,杨瞻宇,关蕊,刘超.术中滑轨CT辅助在经皮骶髂关节螺钉治疗骨盆后环损伤中的应用[J].中国骨伤,2024,37(5):438~444
英文格式:SHENG Bin,WANG Yi-wei,WANG Yu-si,LIU De-long,YANG Zhan-yu,GUAN Rui,LIU Chao.Intraoperative slide rail CT assistance in percutaneous sacroiliac joint screws for the treatment of pelvic posterior ring injury[J].zhongguo gu shang / China J Orthop Trauma ,2024,37(5):438~444
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