Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital, Jiaotong University, 600 Yishan Road, Shanghai, People's Republic of China.
Arch Orthop Trauma Surg. 2010 Sep;130(9):1177-83. doi: 10.1007/s00402-010-1095-2. Epub 2010 Apr 3.
The treatment of displaced acetabular fractures with formal open reduction and internal fixation has gained general acceptance. However, extensile exposure can lead to complications. Two-dimensional fluoroscopy-based computerized navigation for placement of percutaneous screw across non-displaced acetabular fractures has attracted interest by making use of stored patient-specific imaging data to provide real-time guidance in multiple image planes during implant placement. The purpose of the present study was to document early treatment results and complications associated with this new technique and evaluate its clinical application to displaced acetabular fractures amenable to closed or limited open reduction.
Eighteen adult patients with 12 non-displaced and 8 displaced acetabular fractures were treated with percutaneous screw fixation under the guidance of a fluoroscopy-based navigation system. There were 14 men and four women with a mean age of 42.1 years (range 19-54 years). According to the AO and Orthopaedic Trauma Association Classification, there were nine 62-A3, five 62-B1, three 62-B2, and three 62-B3. The mean follow-up was 21 months (range 12-28 months). The mean time from injury to surgery was 4 days (range 2-7 days).
A total of 30 acetabular screws were inserted, including 21 anterior column screws and 9 posterior column screws. The average operation time was 24.6 min (range 16-47 min) from the image acquisition to wound closure. The average fluoroscopic time was 28.4 s (range 11-58 s). Compared to the final position of the screw, the average deviated distance of wire tip was 2.5 mm (range 1.1-3.6 mm) and the average trajectory difference was 2.45 degrees (range 1.5 degrees -4.6 degrees ). Maximal gap displacement averaged 10 mm (range 2-22 mm) preoperatively and 3 mm (range 0-5 mm) postoperatively; while maximal step displacement averaged 4 mm (range 1-10 mm) preoperatively and 2 mm (range 0-4 mm) postoperatively. One patient sustained a transient femoral nerve palsy and resolved 2 months after the operation. No superficial or deep infection occurred. Using the rating system of D'Aubigne and Postel, 13 patients had excellent results, 4 patients had good results, and 1 patient had a fair result.
Percutaneous screw fixation of acetabular fractures with 2D fluoroscopy-based navigation could be applied not only to non-displaced fractures but also to displaced fractures amenable to closed or limited open reduction.
采用正规的切开复位内固定治疗髋臼移位骨折已被普遍接受。然而，广泛的显露可能会导致并发症。二维透视基于计算机导航技术可用于经皮螺钉固定非移位髋臼骨折，它利用存储的患者特定影像学数据在多个影像平面上提供实时引导，从而为植入物放置提供了帮助。本研究的目的是记录该新技术的早期治疗结果和相关并发症，并评估其在可闭合或有限切开复位的髋臼移位骨折中的临床应用。
18 例成人患者，其中 12 例为非移位性髋臼骨折，8 例为移位性髋臼骨折，采用透视基于导航系统引导下经皮螺钉固定治疗。男性 14 例，女性 4 例，平均年龄 42.1 岁（19-54 岁）。根据 AO 和骨科创伤协会分类，其中 9 例为 62-A3 型，5 例为 62-B1 型，3 例为 62-B2 型，3 例为 62-B3 型。平均随访时间为 21 个月（12-28 个月）。从受伤到手术的平均时间为 4 天（2-7 天）。
共置入 30 枚髋臼螺钉，其中前柱螺钉 21 枚，后柱螺钉 9 枚。从图像采集到伤口闭合，平均手术时间为 24.6 分钟（16-47 分钟）。平均透视时间为 28.4 秒（11-58 秒）。与螺钉最终位置相比，导丝尖端的平均偏差距离为 2.5 毫米（1.1-3.6 毫米），平均轨迹差异为 2.45 度（1.5 度-4.6 度）。术前最大间隙移位平均为 10 毫米（2-22 毫米），术后为 3 毫米（0-5 毫米）；术前最大台阶移位平均为 4 毫米（1-10 毫米），术后为 2 毫米（0-4 毫米）。1 例患者发生一过性股神经麻痹，术后 2 个月缓解。无浅表或深部感染。采用 D'Aubigne 和 Postel 评分系统，13 例患者疗效优，4 例患者疗效良，1 例患者疗效可。
二维透视基于导航技术辅助经皮螺钉固定髋臼骨折不仅适用于非移位骨折，也适用于可闭合或有限切开复位的移位骨折。
