| 周唯,汪国栋,裴璇,等.导航下经皮加长骶髂螺钉与经皮重建钢板治疗垂直不稳定型骶骨骨折的疗效比较.骨科,2023,14(3): 222-227. |
| 导航下经皮加长骶髂螺钉与经皮重建钢板治疗垂直不稳定型骶骨骨折的疗效比较 |
| Comparison of Efficacy between 3D Navigation-Assisted Percutaneous Long Sacroiliac Screws and Percutaneous Reconstruction Plate in Treating Vertically Unstable Sacral Fractures |
| 投稿时间：2022-09-12 |
| DOI：10.3969/j.issn.1674-8573.2023.03.005 |
| 中文关键词: 骨盆 骨折固定术，内 骨钉 导航 |
| 英文关键词: Pelvis Fracture fixation, internal Bone nails Navigation |
| 基金项目:卫勤保障能力创新与生成专项（20WQ034）；湖北省卫生健康委2021年转化医学项目（WJ2021ZH0010） |
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| 中文摘要: |
| 目的 比较导航下经皮加长骶髂螺钉与经皮重建钢板治疗垂直不稳定型骶骨骨折的临床疗效。方法 回顾性分析2014年5月至2021年5月中国人民解放军中部战区总医院骨科收治的52例垂直不稳定型骶骨骨折病人的临床资料，按置入内固定的不同分为加长螺钉组（25例）和钢板组（27例）。加长螺钉组采用导航辅助下经皮加长骶髂螺钉内固定治疗，钢板组采用后路经皮重建钢板内固定治疗。比较两组病人的手术时间、术中出血量、术中透视时间、术后疼痛视觉模拟量表（visual analogue scale，VAS）评分、骨折复位情况以及骨盆功能恢复情况，并观察术后并发症发生情况。结果 52例病人均获随访，随访时间为12~25个月，平均14.1个月。加长螺钉组手术时间与术中出血量均少于钢板组［（79.6±18.3） min vs.（131.3±18.9） min，（34.2±24.4） mL vs. （252.9±120.3） mL，P＜0.001］；钢板组术中透视时间少于加长螺钉组［（41.5±23.9） s vs. （176.4±61.5） s，P＜0.001］；加长螺钉组术后3天、术后2周VAS评分［4（4，5）分、3（2，3）分］均少于钢板组［5（4，6）分、4（4，4）分］（P＜0.05），两组病人术后1个月、6个月VAS评分比较，差异均无统计学意义（P＞0.05）；两组病人术后骨折复位情况Matta标准评分与骨盆Majeed功能评分比较，差异均无统计学意义（P＞0.05）。加长螺钉组有2例病人术后出现螺钉松动退钉，两组病人术后均未出现内固定断裂以及骨折复位丢失并发症。结论 导航下经皮加长骶髂螺钉内固定与经皮重建钢板内固定治疗垂直不稳定型骶骨骨折，均可获得良好的复位与功能效果，但前者较后者具有手术时间短、术中出血量少、手术创伤小、疼痛减轻等优势，值得临床推广应用。 |
| 英文摘要: |
| Objective To compare the efficacy between 3D navigation-assisted percutaneous long sacroiliac screws and percutaneous reconstruction plate in treating vertically unstable sacral fractures. Methods A retrospective study was conducted on 52 patients with vertically unstable sacral fracture who had been treated surgically from May 2014 to May 2021 at Central Theater General Hospital. A total of 52 Patients were divided into long screw group and plate group depending on the placement of the internal fixation. Of them, 25 patients were treated by percutaneous long sacroiliac screws with 3D navigation and 27 were treated by percutaneous reconstruction plate. The operation time, intraoperative blood loss, X-ray exposure time, postoperative visual analogue scale (VAS), fracture reduction, pelvic function recovery were compared between the two groups, and postoperative complications were observed. Results All 52 patients were followed up for 12-25 months (mean, 14.1 months). The operation time (79.6±18.3 min) and intraoperative blood loss (34.2±24.4 mL) in the navigation group were significantly less than those in the plate group ［(131.3±18.9) min, (252.9±120.3) mL］ (P＜0.001). The X-ray exposure time in the plate group (41.5±23.9 min) was shorter than that in the navigation group (176.4±61.5 min, P＜0.001). The VAS score in the navigation group ［4 (4, 5) points, 3 (2, 3) points］ was lower than that in the plate group ［5 (4, 6) points, 4 (4, 4) points］ at postoperative 3 days and 2 weeks (P＜0.05). There were no significant differences between the two groups in the VAS scores at postoperative 1 months and 6 months, Matta scores for quality of fracture reduction or Majeed scores for the pelvic function (P＞0.05). There were 2 patients in the navigation group who had screw retraction after surgery. None of the patients reported the postoperative complications like internal fixation breaking or fracture reduction failure. Conclusion The vertically unstable sacral fractures could be treated successfully with percutaneous reconstruction plate and 3D navigation-assisted percutaneous long sacroiliac screws. However, the long screw group has the advantages of shorter operation time, less bleeding, less trauma, less postoperative pain. It is worth promoting in clinical practice. |
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