三维透视导航下髋臼骨折的经皮螺钉固定术

Three-dimensional fluoroscopy-navigated percutaneous screw fixation of acetabular fractures.

作者信息

Schwabe Philipp, Altintas Burak, Schaser Klaus-Dieter, Druschel Claudia, Kleber Christian, Haas Norbert P, Maerdian Sven

机构信息

Center for Musculoskeletal Surgery and Julius Wolff Institute, Charité-University Medicine Berlin, Berlin, Germany.

出版信息

J Orthop Trauma. 2014 Dec;28(12):700-6; discussion 706. doi: 10.1097/BOT.0000000000000091.

DOI:10.1097/BOT.0000000000000091

PMID:24662989

Abstract

OBJECTIVE

Anatomic reduction and articular restoration after acetabular fractures occur (Ac-Fxs) are accepted predictors for good function and slow progression of posttraumatic osteoarthritis of the hip. The aim of this study was to retrospectively analyze Ac-Fxs, which were treated with closed reduction and percutaneous (three-dimensional) fluoroscopy-based navigated screw fixation.

DESIGN

Level 4, retrospective clinical and radiographic assessment.

SETTING

Level 1 trauma center.

PATIENTS

Twelve patients (male/female: 9/3; mean age: 60 years; range: 16-80 years) with moderately displaced Ac-Fxs were included.

INTERVENTION

In enrolled patients, the treatment involved percutaneous three-dimensional fluoroscopy-based navigated lag screw positioning. Closed reduction was achieved by lag screws, or reduction was aided by the insertion of percutaneous Schanz pins.

MAIN OUTCOME MEASUREMENTS

The quality of the reduction and screw positions were assessed using intraoperative and postoperative computed tomography scans. Functional outcome was assessed using the Harris hip score, the visual analog scale for pain, and the Tegener activity scale.

RESULTS

A total of 22 periacetabular screws were placed (mean: 1.8 ± 1.1 screws/patient, range: 1-5). The mean follow-up was done for 30 (16-72) months. The postoperative reduction was anatomical in all patients, and the mean fracture displacement was significantly reduced (gap: 4.1 ± 1.8 mm to 0.4 ± 0.7 mm/step: 1.4 ± 0.6 mm to 0.2 ± 0.4 mm). No secondary dislocations or malunions/nonunions were found. All screws correctly addressed the fracture morphology and corresponded to preoperative planning. The Harris hip score, the visual analog scale (motion), and Tegener activity scale showed excellent to very good results (92.4 ± 6.8, 1.9 ± 1.3, and 3.8 ± 1.6, respectively).

CONCLUSIONS

The navigated, percutaneous screw fixation of selected Ac-Fxs is a promising method that allows for closed reduction and fixation while obtaining a very good radiographic and functional outcome.

LEVEL OF EVIDENCE

Therapeutic level 4.

摘要

目的

髋臼骨折（Ac-Fxs）后实现解剖复位和关节面恢复是髋关节功能良好及创伤后骨关节炎进展缓慢的公认预测指标。本研究的目的是回顾性分析采用闭合复位和基于经皮（三维）透视导航螺钉固定治疗的髋臼骨折。

设计

4级，回顾性临床和影像学评估。

设置

1级创伤中心。

患者

纳入12例髋臼骨折中度移位患者（男/女：9/3；平均年龄：60岁；范围：16 - 80岁）。

干预

在入组患者中，治疗包括基于经皮三维透视导航的拉力螺钉定位。通过拉力螺钉实现闭合复位，或通过插入经皮斯氏针辅助复位。

主要观察指标

使用术中及术后计算机断层扫描评估复位质量和螺钉位置。使用Harris髋关节评分、疼痛视觉模拟量表和Tegener活动量表评估功能结果。

结果

共置入22枚髋臼周围螺钉（平均：1.8 ± 1.1枚/患者，范围：1 - 5枚）。平均随访30（16 - 72）个月。所有患者术后复位均为解剖复位，平均骨折移位显著减小（间隙：4.1 ± 1.8 mm至0.4 ± 0.7 mm/台阶：1.4 ± 0.6 mm至0.2 ± 0.4 mm）。未发现继发性脱位或畸形愈合/不愈合。所有螺钉均正确贴合骨折形态且与术前规划相符。Harris髋关节评分、视觉模拟量表（活动度）和Tegener活动量表显示结果优异至非常好（分别为92.4 ± 6.8、1.9 ± 1.3和3.8 ± 1.6）。