| 李尚志,鲍飞龙,亢世杰,等.折弯反向导针技术在经皮逆行耻骨上支螺钉治疗骨盆前环损伤中的应用研究.骨科,2023,14(3): 233-237. |
| 折弯反向导针技术在经皮逆行耻骨上支螺钉治疗骨盆前环损伤中的应用研究 |
| “Bending Reverse Guide Wire” Technique for Placement of Superior Pubic Ramus Screw in Pelvic Surgery |
| 投稿时间：2023-04-23 |
| DOI：10.3969/j.issn.1674-8573.2023.03.007 |
| 中文关键词: 骨盆损伤 耻骨支 逆行螺钉 微创 手术技术 |
| 英文关键词: Pelvic injury Pubic ramus Retrograde screw Minimally invasive trauma Surgery techniques |
| 基金项目:青岛市市级临床重点专科（QDZDZK-2022095） |
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| 中文摘要: |
| 目的 探讨折弯反向导针技术在经皮逆行耻骨上支螺钉治疗骨盆前环损伤中的安全性、准确性和临床疗效。方法 回顾性分析2020年6月至2022年6月在我院采用折弯反向导针技术经皮逆行耻骨上支螺钉置入治疗的13例骨盆损伤病人的临床资料，其中男9例，女4例；年龄为31~76岁，平均50.7岁；单纯耻骨上支骨折2例，合并骨盆后环损伤的11例。常规导针置入失败后，空心钻开口，钝头折弯在前进入髓腔，旋转导针使其尖部指向近骨折端髓腔或远离关节，锤击导针顺利通过，选择合适的6.5 mm空心钉内固定。依据术后影像学检查及体格检查评价该手术方法的安全性和准确性。统计置入逆行耻骨上支髓内螺钉的透视次数和手术时间。末次随访采用Majeed评分评价骨盆骨折术后功能恢复情况。结果 13例病人共置入14颗螺钉。置入1枚螺钉所需透视次数为28~49次，平均37次；手术时间为18~60 min，平均32 min。术后CT证实14枚螺钉完全位于骨内，均未突破耻骨支及髋臼骨皮质。术后所有病人均无血管、神经或泌尿生殖系统及切口感染并发症。病人术后获6~20个月随访，平均10个月。除1例于术后1个月首次复查发现松动，后减少下地活动，延迟愈合外，其他病人均于术后3个月左右复查时愈合，平均愈合时间为98天。末次随访时根据Majeed评分，优10例，良3例。结论 折弯反向导针技术可以有效提高经皮逆行耻骨上支螺钉置入的可操作性，尤其是狭窄髓腔，其准确性、安全性高，可减少术中透视次数和手术时间，值得临床推广借鉴。 |
| 英文摘要: |
| Objective To explore the safety, accuracy and clinical efficacy of “bending reverse guide wire” technique for placement of superior pubic ramus screw in pelvic surgery. Methods A retrospective study was used to analyze the clinical data of 13 patients with pelvic fractures who had been treated with “bending reverse guide wire” technique for placement of superior pubic ramus screw in our hospital from June 2020 to June 2022, including 9 males and 4 females. Patients were aged 31 to 76 years, mean 50.7 years. There were 2 cases of isolated superior pubic ramus fractures and 11 cases of combined with posterior ring injuries. Once routine guide wire failed to insert, we bended the blunt end of guide wire. After enlarging the entry point by cannulated drill, the bended blunt guide wire was introduced, rotating the guide wire to align it with the medullary cavity or away from the joint, then advancing it with light hammering. The safety and accuracy were evaluated by physical examination and postoperative CT-Scan. The operative time and number of fluoroscope were calculated for each retrograde intramedullary screw insertion. The Majeed score was used to assess the functional results of the pelvic injury at the last follow-up. Results A total of 14 retrograde superior pubic ramus medullary screws were inserted in 13 patients using “bending reverse guide wire” technique. Fluoroscope number per screw, including preoperative imaging, ranged from 28-49 times, with a mean of 37 times. The total time for each screw insertion ranged from 18 min to 60 min, mean 32 min. There were no iatrogenic neurovascular and genitourinary system injury in all patients. All the 14 screws were located in the bone verified by the CT-scan. A total of 13 patients were followed up for 6 to 20 months (mean 10 months). Except for one patient who was found to be loose during the first follow-up examination one month after surgery, and subsequently reduced ground movement and delayed healing, all other patients healed around 3 months after surgery, with an average healing time of 98 d. The Majeed scores at the last follow-up for the 13 patients were excellent in 10 and good in 3. Conclusion “Bending reverse guide wire” technique can improve effectively the manipuility of superior pubic ramus screw, especially in difficult patients. This technique has high safety, accuracy and minimally invasive trauma, and is worthy of clinical promotion. |
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