Cunningham Brian, Jackson Kelly, Ortega Gil
Orthopedics. 2014 Apr;37(4):e328-31. doi: 10.3928/01477447-20140401-51.
Posterior wall acetabular fractures that involve 10% to 40% of the posterior wall may or may not require an open reduction and internal fixation. Dynamic stress examination of the acetabular fracture under fluoroscopy has been used as an intraoperative method to assess joint stability. The aim of this study was to demonstrate the value of intraoperative ISO computed tomography (CT) examination using the Siemens ISO-C imaging system (Siemens Corp, Malvern, Pennsylvania) in the assessment of posterior wall acetabular fracture stability during stress examination under anesthesia. In 5 posterior wall acetabular fractures, standard fluoroscopic images (including anteroposterior pelvis and Judet radiographs) with dynamic stress examinations were compared with the ISO-C CT imaging system to assess posterior wall fracture stability during stress examination. After review of standard intraoperative fluoroscopic images under dynamic stress examination, all 5 cases appeared to demonstrate posterior wall stability; however, when the intraoperative images from the ISO-C CT imaging system demonstrated that 1 case showed fracture instability of the posterior wall segment during stress examination, open reduction and internal fixation was performed. The use of intraoperative ISO CT imaging has shown an initial improvement in the surgeon's ability to assess the intraoperative stability of posterior wall acetabular fractures during stress examination when compared with standard fluoroscopic images.
累及髋臼后壁10%至40%的后壁髋臼骨折可能需要也可能不需要切开复位内固定。在透视下对髋臼骨折进行动态应力检查已被用作评估关节稳定性的术中方法。本研究的目的是证明使用西门子ISO-C成像系统（西门子公司，宾夕法尼亚州马尔伯勒）进行术中ISO计算机断层扫描（CT）检查在麻醉下应力检查期间评估后壁髋臼骨折稳定性的价值。在5例后壁髋臼骨折中，将标准透视图像（包括骨盆前后位和Judet位X线片）及动态应力检查结果与ISO-C CT成像系统进行比较，以评估应力检查期间后壁骨折的稳定性。在动态应力检查下回顾标准术中透视图像后，所有5例均显示后壁稳定；然而，当ISO-C CT成像系统的术中图像显示1例在应力检查期间后壁节段存在骨折不稳定时，进行了切开复位内固定。与标准透视图像相比，术中使用ISO CT成像已初步提高了外科医生在应力检查期间评估后壁髋臼骨折术中稳定性的能力。
