经皮逆行前后柱螺钉固定无明显移位的髋臼骨折△

Percutaneous retrograde screwing in the treatment of slightly displaced acetabular fractures

摘要:

[目的]介绍经皮逆行前后柱螺钉固定无明显移位的髋臼骨折的手术技术和初步临床结果。[方法]对 19 例无明显移位髋臼骨折患者行逆行经皮前后柱螺钉内固定术治疗。术前利用相关计算机软件技术进行虚拟手术设计，获得个体化置钉参数，结合术前规划及术中透视确定入针点，钝性分离至骨面，于入针点置入导针，C 形臂 X 线机透视确定导针走向，确保安全无误后置入螺钉。[结果]19 例患者均顺利置入逆行髋臼前后柱螺钉，无神经血管损伤和穿入髋关节腔。手术时间平均（99.7± 18.8） min，术中透视次数平均 （97.6±16.6） 次，术后复查 X 线和 CT 示螺钉位置及长度满意。末次随访时 Merle d' Aubigne 和 Postel 功能评分优良率为 89.4%。均未发生螺钉松动断裂、骨折不愈合及再移位等并发症。[结论]经皮逆行髋臼前后柱螺钉内固定结合术前计算机进行个体规划治疗无明显移位髋臼骨折是一种微创可行的技术，可短期内取得良好临床结局。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical results of percutaneous retrograde screw fixation of acetabular fractures without significant displacement. [Methods] A total of 19 patients received percutaneous retrograde screw fixation of unremarkably displaced acetabular fractures. Preoperative virtual surgical design was carried out by using relevant computer software technology to obtain individualized screw placement parameters. The insertion point was determined by combining preoperative planning and intraoperative fluoroscopy, and the blunt separation to the bone surface was conducted. The guide wire was placed at the entry point with direction determined by C-arm fluoroscopy. Finally the screws were individually placed to fix the fracture in safe and accurate manner. [Results] All the 19 patients had percutaneous retrograde acetabular anterior-posterior column screws placed successfully without neurovascular injury or involvement of the hip cavity, with average operation time of (99.7±18.8) min, and the average intraoperative fluoroscopy times of (97.6±16.6). The postoperative X-ray and CT recheck revealed satisfactory screw placement in position and length. At the last follow-up, the excellent rate of the Merle d 'Aubigne and Postel functional scores was 89.4%, and no complications such as screw loosening and broken, fracture nonunion and re-displacement were found in anyone of them. [Conclusion] This percutaneous retrograde acetabular anteriorposterior column screw fixation based on individual preoperative computer planning for the treatment of non-displaced acetabular fractures is feasible minimal invasive technique and does achieve good clinical outcomes in a short period of time.