【摘要】：目的:探討O-arm導(dǎo)航系統(tǒng)引導(dǎo)下內(nèi)固定治療不穩(wěn)定性骨盆后環(huán)損傷的臨床效果。方法:2015年9月至2017年1月我院共收住40例骨盆后環(huán)損傷的患者,19例應(yīng)用O-arm導(dǎo)航系統(tǒng)閉合引導(dǎo)骶髂關(guān)節(jié)空心拉力螺釘植入(實驗組);21例應(yīng)用傳統(tǒng)C型臂透視閉合指導(dǎo)植入骶髂關(guān)節(jié)空心拉力螺釘植入(對照組),比較兩組病例手術(shù)時間、術(shù)中出血量、置釘情況、復(fù)位情況、術(shù)后功能情況。按照Tile分型O-arm導(dǎo)航組: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型臂透視組: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。結(jié)果O-arm導(dǎo)航組共置入骶髂螺釘23枚,優(yōu)18枚,良4枚,差1枚,總優(yōu)良率95.7%。C型臂透視組共置入骶髂螺釘26枚,優(yōu)14枚,良7枚,差5枚,總優(yōu)良率80.8%。O-arm導(dǎo)航組螺釘置入耗時18~27min,平均(24.19±3.14)min;出血量11~25ml,平均(19±5.26)ml。C型臂透視組螺釘置入耗時26~38min,平均(25.35±4.38)min;出血量13~27ml,平均(20±6.36)ml。兩組各失隨訪1例。兩組病例傷口均Ⅰ期愈合,無傷口感染的并發(fā)癥。O-arm導(dǎo)航組術(shù)后均未出現(xiàn)明顯神經(jīng)系統(tǒng)并發(fā)癥。C型臂透視組術(shù)后2例出現(xiàn)下肢麻木,預(yù)脫水、應(yīng)用激素、營養(yǎng)神經(jīng)等對癥治療3個月后恢復(fù)。采用Matta評分標準評價骨折復(fù)位情況:O-arm導(dǎo)航組優(yōu)13例,良5例,差1例,總體優(yōu)良率94.7%;C型臂透視組優(yōu)12例,良7例,差2例,總體優(yōu)良率90.5%。O-arm導(dǎo)航組術(shù)后1個月和術(shù)后3個月的Majeed功能評分較C型臂透視組提高。結(jié)論O-arm導(dǎo)航輔助下內(nèi)固定治療不穩(wěn)定型骨盆后環(huán)損傷,可以縮短手術(shù)時間,提高內(nèi)固定物的準確性,手術(shù)操作簡便,安全,手術(shù)出血少,手術(shù)符合骨科微創(chuàng)醫(yī)療原則和精準醫(yī)療原則,更有利于患者術(shù)后功能的恢復(fù)。
[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.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3

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