Department of Orthopaedic Surgery, Chubu Tokushukai Hospital, 801 Higa, Kitanakagusuku, Nakagami-gun, Okinawa, 901-2393, Japan.
Department of Orthopaedic Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Aza-Uehara, Nishihara, Nakagami-gun, Okinawa, 903-0215, Japan.
BMC Musculoskelet Disord. 2022 Dec 3;23(1):1057. doi: 10.1186/s12891-022-06026-w.
The prognosis of conservative treatment for fragility fracture of the pelvis (FFP) in the older patients remains poor. Percutaneous pelvic screw placement (PPSP), which aids in the treatment of FFP, can be challenging to perform using fluoroscopy alone because of the proximity of blood vessels and neuroforamina. Hence, this study aimed to investigate the accuracy and clinical outcomes of PPSP using real-time 3D fluoroscopic navigation for FFP in the hybrid operating room.
This study included 41 patients with FFP who underwent PPSP in a hybrid operating room between April 2016 and December 2020. Intraoperative C-arm cone-beam CT was performed under general anesthesia. Guidewire trajectory was planned using a needle guidance system. The guidewire was inserted along the overlaid trajectory using 3D fluoroscopic navigation, and a 6.5 mm cannulated cancellous screw (CCS) was placed. The clinical outcomes and accuracy of the screw placement were then investigated.
A total of 121 screws were placed. The mean operative time was 84 ± 38.7 minutes, and the mean blood loss was 7.6 ± 3.8 g. The mean time to wheelchair transfer was 2 days postoperatively. Pain was relieved in 35 patients. Gait ability from preoperative and latest follow-up after surgery was maintained in 30 (73%) patients. All 41 patients achieved bone union. Of the 121 screws, 119 were grade 0 with no misplacement; only 2 patients had grade 1 perforations.
PPSP using real-time 3D fluoroscopic navigation in a hybrid operating room was accurate and useful for early mobilization and pain relief among older patients with FFP with an already-installed needle biopsy application.
对于老年骨盆脆弱性骨折（FFP）的保守治疗，其预后仍然较差。经皮骨盆螺钉固定术（PPSP）可辅助治疗 FFP，但由于血管和神经孔的位置接近，单独使用透视可能难以进行。因此，本研究旨在探讨在杂交手术室中使用实时三维透视导航进行 PPSP 的准确性和临床结果。
本研究纳入了 2016 年 4 月至 2020 年 12 月期间在杂交手术室接受 PPSP 的 41 例 FFP 患者。全身麻醉下进行术中 C 臂锥束 CT。使用针引导系统规划导丝轨迹。导丝沿重叠轨迹插入，使用三维透视导航，然后放置 6.5 毫米空心松质骨螺钉（CCS）。然后研究了螺钉放置的临床结果和准确性。
共放置了 121 枚螺钉。平均手术时间为 84 ± 38.7 分钟，平均失血量为 7.6 ± 3.8 克。术后平均 2 天可转轮椅。35 例患者疼痛缓解。30 例（73%）患者术前和术后最新随访的步态能力保持不变。所有 41 例患者均达到骨愈合。在 121 枚螺钉中，119 枚为 0 级，无错位；仅 2 例有 1 级穿孔。
在已安装针活检应用的杂交手术室中使用实时三维透视导航进行 PPSP 准确且有助于老年 FFP 患者早期活动和缓解疼痛。
