Orthopedic Trauma Center, National Institute of Traumatology and Orthopedics, Avenida Brasil 500, Rio de Janeiro, RJ, 20940-070, Brazil.
Research Division, National Institute of Traumatology and Orthopedics, Avenida Brasil 500, Rio de Janeiro, RJ, 20940-070, Brazil.
Int Orthop. 2019 May;43(5):1205-1213. doi: 10.1007/s00264-018-3989-5. Epub 2018 Jun 8.
Percutaneous fixation of the acetabulum is a treatment option for select acetabular fractures. Intra-operative fluoroscopy is required, and despite various described imaging strategies, it is debatable as to which combination of fluoroscopic views provides the most accurate and reliable assessment of screw position.
Using five synthetic pelvic models, an experimental setup was created in which the anterior acetabular columns were instrumented with screws in five distinct trajectories. Five fluoroscopic images were obtained of each model (Pelvic Inlet, Obturator Oblique, Iliac Oblique, Obturator Oblique/Outlet, and Iliac Oblique/Outlet). The images were presented to 32 pelvic and acetabular orthopaedic surgeons, who were asked to draw two conclusions regarding screw position: (1) whether the screw was intra-articular and (2) whether the screw was intraosseous in its distal course through the bony corridor.
In the assessment of screw position relative to the hip joint, accuracy of surgeon's response ranged from 52% (iliac oblique/outlet) to 88% (obturator oblique), with surgeon confidence in the interpretation ranging from 60% (pelvic inlet) to 93% (obturator oblique) (P < 0.0001). In the assessment of intraosseous position of the screw, accuracy of surgeon's response ranged from 40% (obturator oblique/outlet) to 79% (iliac oblique/outlet), with surgeon confidence in the interpretation ranging from 66% (iliac oblique) to 88% (pelvic inlet) (P < 0.0001).
The obturator oblique and obturator oblique/outlet views afforded the most accurate and reliable assessment of penetration into the hip joint, and intraosseous position of the screw was most accurately assessed with pelvic inlet and iliac oblique/outlet views.
Clinical Question.
经皮固定髋臼是治疗髋臼骨折的选择之一。术中需要透视，尽管有各种描述的成像策略，但哪种透视视图组合能提供最准确和可靠的螺钉位置评估仍存在争议。
使用五个合成骨盆模型，创建了一个实验设置，其中在前髋臼柱中用五个不同轨迹的螺钉进行了器械固定。对每个模型获得了五个透视图像（骨盆入口，闭孔斜位，髂骨斜位，闭孔斜位/出口和髂骨斜位/出口）。将这些图像呈现给 32 名骨盆和髋臼矫形外科医生，要求他们就螺钉位置做出两个结论：（1）螺钉是否在关节内，（2）螺钉在通过骨通道的远端骨内行程中是否在骨内。
在评估螺钉相对于髋关节的位置时，外科医生的反应准确性范围为 52%（髂骨斜位/出口）至 88%（闭孔斜位），外科医生对解释的信心范围为 60%（骨盆入口）至 93%（闭孔斜位）（P<0.0001）。在评估螺钉的骨内位置时，外科医生的反应准确性范围为 40%（闭孔斜位/出口）至 79%（髂骨斜位/出口），外科医生对解释的信心范围为 66%（髂骨斜位）至 88%（骨盆入口）（P<0.0001）。
闭孔斜位和闭孔斜位/出口视图提供了对髋关节穿透的最准确和可靠的评估，而骨盆入口和髂骨斜位/出口视图最能准确评估螺钉的骨内位置。
临床问题。
