导航下经皮空心螺钉固定DayⅡ型骨盆骨折脱位

Percutaneous cannulated screws for Day typeⅡcrescent fracture and dislocation of pelvis under navigation

摘要:

[目的]介绍导航下经皮空心螺钉治疗 Day II 型骨盆新月形骨折脱位（crescent fracture dislocation of pelvis, CFDP）的手术技术和初步临床效果。[方法]2015 年 1 月—2021 年 12 月对 23 例 Day II 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。先在导航下将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 螺钉平行钻入第 2 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（2.3±0.3）min。术后 6 个月 Majeed 功能评分较术前显著增加 [(87.3±1.6) vs (18.5±1.1), P＜0.05]。影像方面，根据 Gras 分类螺钉安全置钉率为 95.6%（22/23）；根据 Matta 影像学标准骨折复位优良率为 91.3%（21/23）。[结论]导航下经皮空心螺钉治疗 Day II 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 under navigation for Day typeⅡcrescent fracture dislocation of the pelvis (CFDP). [Methods] From January 2015 to December 2018, 23 patients received abovesaid surgical treatment for Day typeⅡ CFDP. As Mimics 17.0 software was used to plan screws fixation before operation, an orthopedic 3D navigation was used during the operation. After the screw track was determined, the registration of navigation was completed centering on the sacroiliac joint of 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 posterior to the "teardrop". Subsequently, the CLIC point was used as the entering point to place the second screw parallel to the LC-Ⅱ screw. [Results] All the 23 patients had operation performed successfully without complications such as neuro- vascular injury. The time for LC-II screw placement ranged from 1.8 min to 3.0 min with an average of (2.3±0.3) min. The Majeed functional score significantly increased 6 months postoperatively compared with that preoperatively [(87.3±1.6) vs (18.5±1.1), P＜0.05]. According to Gras classification, the safe screw placement rate was of 95.6% (22/23). In addition, the excellent and good rate of fracture reduction was 91.3% (21/23) based on Matta's imaging criteria. [Conclusion] This percutaneous cannulated screw under navigation for Day type Ⅱ CFDP has the advantages of low radiation exposure, accurate screw placement, satisfactory fracture reduction, and good functional recovery.