O-arm导航辅助内固定治疗不稳定性骨盆后环损伤的临床研究

发布时间：2018-08-26 14:32

【摘要】：目的:探讨O-arm导航系统引导下内固定治疗不稳定性骨盆后环损伤的临床效果。方法:2015年9月至2017年1月我院共收住40例骨盆后环损伤的患者,19例应用O-arm导航系统闭合引导骶髂关节空心拉力螺钉植入(实验组);21例应用传统C型臂透视闭合指导植入骶髂关节空心拉力螺钉植入(对照组),比较两组病例手术时间、术中出血量、置钉情况、复位情况、术后功能情况。按照Tile分型O-arm导航组:B1.2型7例,B2.2型8例,C1.2型2例,C1.3型1例,C2.3型1例。C型臂透视组:B1.2型9例,B2.2型7例,C1.2型2例,C1.3型2例,C2.3型1例。结果O-arm导航组共置入骶髂螺钉23枚,优18枚,良4枚,差1枚,总优良率95.7%。C型臂透视组共置入骶髂螺钉26枚,优14枚,良7枚,差5枚,总优良率80.8%。O-arm导航组螺钉置入耗时18~27min,平均(24.19±3.14)min;出血量11~25ml,平均(19±5.26)ml。C型臂透视组螺钉置入耗时26~38min,平均(25.35±4.38)min;出血量13~27ml,平均(20±6.36)ml。两组各失随访1例。两组病例伤口均Ⅰ期愈合,无伤口感染的并发症。O-arm导航组术后均未出现明显神经系统并发症。C型臂透视组术后2例出现下肢麻木,预脱水、应用激素、营养神经等对症治疗3个月后恢复。采用Matta评分标准评价骨折复位情况:O-arm导航组优13例,良5例,差1例,总体优良率94.7%;C型臂透视组优12例,良7例,差2例,总体优良率90.5%。O-arm导航组术后1个月和术后3个月的Majeed功能评分较C型臂透视组提高。结论O-arm导航辅助下内固定治疗不稳定型骨盆后环损伤,可以缩短手术时间,提高内固定物的准确性,手术操作简便,安全,手术出血少,手术符合骨科微创医疗原则和精准医疗原则,更有利于患者术后功能的恢复。
[Abstract]:Objective:To investigate the clinical effect of O-arm navigation system-guided internal fixation in the treatment of unstable posterior pelvic ring injuries.Methods:From September 2015 to January 2017,40 patients with posterior pelvic ring injuries were admitted to our hospital. The operation time, intraoperative bleeding volume, screw placement, reduction and postoperative function were compared between the two groups. According to Tile classification, O-arm navigation group: B1.2 in 7 cases, B2.2 in 8 cases, C1.2 in 2 cases, C1.3 in 1 case, C2.3 in 1 case. C arm fluoroscopy group: B1.2 in 9 cases, B2.2 in 7 cases, C1.2 in 22 cases. Results In the O-arm group, 23 sacroiliac screws were placed, 18 were excellent, 4 were good and 1 was poor, with a total excellent and good rate of 95.7%. In the C-arm fluoroscopy group, 26 sacroiliac screws were placed, 14 were excellent, 7 were good, and 5 were poor, with a total excellent and good rate of 80.8%. In the O-arm navigation group, the screw placement time was 18-27 minutes, with an average of (24.19 + 3.14) minutes. 6) The time of screw insertion was 26-38 minutes in the O-arm fluoroscopy group, with an average of (25.35 (+ 4.38) minutes, and the amount of bleeding was 13-27 ml, with an average of (20 (+ 6.36) ml). One case was lost in each group. The wounds of the two groups were healed in the first stage without complications of wound infection. Pre-dehydration, hormone, nutritional nerve and other symptomatic treatment for 3 months after recovery. Matta scoring criteria were used to evaluate fracture reduction: O-arm navigation group 13 excellent, 5 good, 1 poor, the overall excellent and good rate was 94.7%; C-arm fluoroscopy group 12 excellent, 7 good, 2 poor, the overall excellent and good rate was 90.5%. O-arm navigation group 1 month and 3 months after the Majeed functional evaluation. Conclusion O-arm navigation-assisted internal fixation for unstable posterior pelvic ring injury can shorten the operation time, improve the accuracy of internal fixation, and the operation is simple, safe and less bleeding. The operation conforms to the principle of minimally invasive orthopedics and precise medical treatment, which is more conducive to the recovery of postoperative function.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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