术前CT模拟指导俯卧位经皮微创骶髂螺钉内固定术的可行性分析

目的分析术前CT模拟指导俯卧位经皮微创骶髂螺钉内固定术的可行性。方法回顾性分析2017年1月-2019年1月河南省开封市中心医院收治的67例骨盆骨折损伤俯卧位行经皮微创骶髂螺钉内固定术患者的临床资料。男性38例,女性29例;年龄30~62岁,平均37.5岁;BMI 17.8~27.2kg/m^2,平均22.5kg/m^2。俯卧位行术前CT模拟指导经皮微创骶髂螺钉内固定术38例(CT模拟组),俯卧位行经皮微创骶髂螺钉内固定术29例(常规组)。比较两组患者置入螺钉数量、位置、长度与术前规划符合率,手术时间、术中透视时间、术中出血量、骨折愈合时间;比较两组患者术后6个月Majeed功能评分和并发症发生情况。结果CT模拟组患者置入螺钉数量和常规组相比,差异无统计学意义(P>0.05);CT模拟组位置、长度与术前规划符合率均为100%,均分别高于常规组的83%和87%,差异均有统计学意义(χ^2=7.179,P=0.007;χ^2=5.657,P=0.017);CT模拟组手术时间、术中透视时间以及骨折愈合时间较常规组缩短,术中出血量降低[(77.9±12.6)min vs.(90.4±13.3)min、(6.5±0.8)s vs.(7.2±0.9)s、(3.2±0.5)个月vs.(3.5±0.6)个月、(86.8±17.1)m L vs.(97.8±18.3)m L],差异有统计学意义(均P<0.05);术后6个月CT模拟组Majeed功能评分中疼痛、工作、坐、站立、性生活及总评分均高于常规组[(25.6±3.6)分vs.(23.6±3.3)分、(17.5±2.3)分vs.(16.3±2.2)分、(8.8±1.3)分vs.(8.1±1.2)分、(31.8±4.9)分vs.(29.4±4.5)分、(3.0±0.5)分vs.(2.8±0.5)分、(86.7±10.2)分vs.(80.2±9.8)分],差异有统计学意义(均P<0.05);CT模拟组并发症发生率为0,低于常规组17%,两组比较差异有统计学意义(P=0.025)。结论术前CT模拟用于指导俯卧位经皮微创骶髂螺钉内固定术可提高置入螺钉位置、长度的精准率,还具有手术时间短、术中出血量和射线辐射少、骨折愈合快、螺钉植入准确率高、并发症发生率低等优点,是一种精确、安全、有效的影像学辅助手段。

Feasibility analysis of anterior CT simulation to guide percutaneous minimally invasive sacroiliac screw internal fixation in prone position

Objective To analyze the feasibility of preoperative CT simulation to guide percutaneous minimally invasive sacroiliac screw fixation in prone position.Methods The clinical data of 67 patients with pelvic fracture who underwent minimally invasive sacroiliac screw fixation in prone position from Jan.2017 to Jan.2019 in Kaifeng Central Hospital of Henan Province were analyzed retrospectively.There were 38 males and 29 females,with an average age of 37.5 years(range,30-62 years).Their average body mass index was 22.5 kg/m^2(range,17.8-27.2 kg/m^2).The 38 patients in the CT simulation group underwent preoperative CT simulation guided percutaneous minimally invasive sacroiliac screw fixation in prone position and 29 cases in the routine group were treated with minimally invasive sacroiliac screw fixation in prone position.The numbers of the screws,coincidence rates of position and length of the screws with the preoperative planning operation moment,intraoperative fluoroscopy time,intraoperative hemorrhage and fracture healing time were compared between the two groups.Majeed function scores and complications were compared between the two groups at 6 months after operation.Results There was no significant difference in the numbers of the screws between the CT simulation group and the routine group(P>0.05).The coincidence rates of position and length of the screws with the preoperative planning operation moment in the CT simulation group were both 100%,which were higher than those of 83%and 87%in the routine group,respectively,with statistically significant differences(χ^2=7.179,P=0.007;χ^2=5.657,P=0.017).Compared with the routine group,the operation time,intraoperative fluoroscopy time and fracture healing time of the CT simulation group were shortened,and the intraoperative bleeding volume was reduced[(77.9±12.6)min vs.(90.4±13.3)min,(6.5±0.8)s vs.(7.2±0.9)s,(3.2±0.5)months vs.(3.5±0.6)months,(86.8±17.1)m L vs.(97.8±18.3)m L],with statistically significant differences(all P values<0.05).The scores of pain,work,sitting,standing,sexual life and total Majeed score of the patients in the CT simulation group were higher than those in the routine group[(25.6±3.6)scores vs.(23.6±3.3)scores,(17.5±2.3)scores vs.(16.3±2.2)scores,(8.8±1.3)scores vs.(8.1±1.2)scores,(31.8±4.9)scores vs.(29.4±4.5)scores,(3.0±0.5)scores vs.(2.8±0.5)scores;(86.7±10.2)scores vs.(80.2±9.8)scores],with statistically significant differences(all P values<0.05).There was no complication in CT simulation group(0),lower than that in routine group(17%),with statistical difference between the two groups(P=0.025).Conclusion Preoperative CT simulation used to guide the minimally invasive sacroiliac screw internal fixation in prone position can improve the accuracy of position and length of the screws,which has the advantages of shorter operation time,less intraoperative bleeding and radiation,faster fracture healing,and lower incidence of complications.The effect of clinical guidance is good,and it is an accurate,safe and effective imaging auxiliary means.