Yu Tong, Cheng Xue-Liang, Qu Yang, Dong Rong-Peng, Kang Ming-Yang, Zhao Jian-Wu
Department of Orthopedics, the Second Hospital of Jilin University, Changchun 130014, Jilin Province, China.
World J Clin Cases. 2020 Jun 26;8(12):2464-2472. doi: 10.12998/wjcc.v8.i12.2464.
Pelvic fractures are often caused by high-energy injuries and accompanied by hemodynamic instability. Traditional open surgery has a large amount of bleeding, which is not suitable for patients with acute pelvic fracture. Navigation-guided, percutaneous puncture-screw implantation has gradually become a preferred procedure due to its advantages, which include less trauma, faster recovery times, and less bleeding. However, due to the complexity of pelvic anatomy, doctors often encounter some problems when using navigation to treat pelvic fractures. This article reviews the indications, contraindications, surgical procedures, and related complications of this procedure for the treatment of sacral fractures, sacroiliac joint injuries, pelvic ring injuries, and acetabular fractures. We also analyze the causes of inaccurate screw placement. Percutaneous screw placement under navigational guidance has the advantages of high accuracy, low incidence of complications and small soft-tissue damage, minimal blood loss, short hospital stays, and quick recovery. There is no difference in the incidence of complications between surgeries performed by new doctors and experienced ones. However, computer navigation technology requires extensive training, and attention should be given to avoid complications such as screw misplacement, intestinal injury, and serious blood vessel and nerve injuries caused by navigational drift.
骨盆骨折通常由高能量损伤引起,并伴有血流动力学不稳定。传统的开放手术出血量大,不适合急性骨盆骨折患者。导航引导下的经皮穿刺螺钉植入术因其创伤小、恢复快、出血少等优点,逐渐成为首选术式。然而,由于骨盆解剖结构复杂,医生在使用导航治疗骨盆骨折时经常会遇到一些问题。本文综述了该术式治疗骶骨骨折、骶髂关节损伤、骨盆环损伤和髋臼骨折的适应证、禁忌证、手术步骤及相关并发症。我们还分析了螺钉置入不准确的原因。导航引导下经皮螺钉置入具有准确性高、并发症发生率低、软组织损伤小、出血量少、住院时间短和恢复快等优点。新医生和经验丰富的医生进行手术的并发症发生率没有差异。然而,计算机导航技术需要大量培训,应注意避免因导航漂移导致的螺钉误置、肠损伤以及严重的血管和神经损伤等并发症。