Zhou Kai-Hua, Luo Cong-Feng, Chen Nong, Hu Cheng-Fang, Pan Fu-Gen
Department of Orthopedics, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai 201700, China.
Indian J Orthop. 2016 May-Jun;50(3):250-5. doi: 10.4103/0019-5413.181791.
The incidence of pelvic fractures in trauma patients is reported to be 3-8.2%, with roughly half of these fractures being caused by high energy injuries with a potential for catastrophic hemorrhage and death. Indications for internal fixation of anterior pelvic ring are controversial. Because of fears of disturbing the pelvic hematoma and causing additional hemorrhage, open reduction and internal fixation of pelvic ring disruption is routinely delayed. In contrast to conventional surgery, percutaneous screw fixation is gaining popularity in the treatment of pelvic and acetabular fractures mainly because of minimal soft tissue damage, less operative blood loss, early surgical intervention and comfortable mobilization of the patient. Fluoro-navigation is a new surgical technique in orthopedic trauma surgery. This study is to investigate clinical results of fluoro-navigation surgery in anterior pelvic ring fractures.
From January 2006 to October 2011, 23 patients with anterior pelvic ring fractures were treated with percutaneous cannulated screw under fluoro-navigation. There were 14 men and 9 women, with a mean age of 40.1 years (range 25-55). According to the AO and Orthopedic Trauma Association classification, there were seven A 2.1, two A 2.2, one A 2.3, six B 1.2, one B 2.1: 1, one B 2.2, one C 1.2, two C 1.3 and two C 2.3 types of fractures. Amongst these patients, 13 had posterior pelvic ring injuries, 8 had other injuries including urethral, lumbar vertebrae fractures and femoral fractures. All patients were operated when their general condition stabilized after emergency management. The mean time from injury to percutaneous screw fixation of the anterior pelvic ring fracture was 12 days (3-15 days). All the anterior ring fractures were fixed with cannulated screws by two senior surgeons. They were familiar with the navigation system and had gained much experience in the computer-assisted percutaneous placement of screws.
A total of 32 screws were inserted, including 19 in the pubic ramis and 13 in the anterior acetabular columns. The average surgical time was 23.3 min/screw. The average time of X-ray exposure was 19.1 ± 2.5 s/screw. The virtual images of fluoro-navigation were compared with real-time X-rays during and after the surgery. Compared to the final position of the screw, the average deviated distance was 3.11 mm and the average trajectory difference was 2.81°. Blood loss during the operation was minimal (22.3 ml/screw). One screw (3.1%) deviated out of the fracture site during the operation. No superficial or deep infection occurred. No patient sustained recognized neurologic, vascular, or urologic injury as a result of the percutaneous screw fixation. All fractures united at the last followup.
Fluoro-navigation technique could become a safe, accurate, and fairly quick method for the treatment of anterior pelvic ring fractures. Standardization of the operative procedure and training are mandatory for the success of this procedure.
据报道，创伤患者骨盆骨折的发生率为3% - 8.2%，其中约一半骨折由高能损伤引起，存在灾难性出血和死亡风险。骨盆前环内固定的适应证存在争议。由于担心扰乱骨盆血肿并导致额外出血，骨盆环断裂的切开复位内固定通常会延迟。与传统手术相比，经皮螺钉固定在骨盆和髋臼骨折治疗中越来越受欢迎，主要是因为软组织损伤最小、术中失血少、能早期进行手术干预且患者活动舒适。荧光导航是骨科创伤手术中的一项新技术。本研究旨在探讨荧光导航手术治疗骨盆前环骨折的临床效果。
2006年1月至2011年10月，23例骨盆前环骨折患者在荧光导航下接受经皮空心螺钉治疗。其中男性14例，女性9例，平均年龄40.1岁（范围25 - 55岁）。根据AO和骨科创伤协会分类，有7例A2.1型、2例A2.2型、1例A2.3型、6例B1.2型、1例B2.1型、1例B2.2型、1例C1.2型、2例C1.3型和2例C2.3型骨折。这些患者中，13例伴有骨盆后环损伤，8例有其他损伤，包括尿道、腰椎骨折和股骨骨折。所有患者在急诊处理后病情稳定时接受手术。骨盆前环骨折经皮螺钉固定的平均受伤至手术时间为12天（3 - 15天）。所有前环骨折均由两位资深外科医生用空心螺钉固定。他们熟悉导航系统，并在计算机辅助经皮螺钉置入方面积累了丰富经验。
共置入32枚螺钉，其中耻骨支19枚，髋臼前柱13枚。平均手术时间为每枚螺钉23.3分钟。平均X线暴露时间为每枚螺钉19.1 ± 2.5秒。术中及术后将荧光导航的虚拟图像与实时X线进行比较。与螺钉最终位置相比，平均偏差距离为3.11毫米，平均轨迹差异为2.81°。术中失血极少（每枚螺钉22.3毫升）。1枚螺钉（3.1%）在手术中偏离骨折部位。未发生浅表或深部感染。经皮螺钉固定未导致任何患者出现公认的神经、血管或泌尿系统损伤。所有骨折在末次随访时均愈合。
荧光导航技术可成为治疗骨盆前环骨折安全、准确且相当快速的方法。该手术成功的关键在于手术操作的标准化和培训。
