山东大学学报 (医学版) ›› 2022, Vol. 60 ›› Issue (10): 17-26.doi: 10.6040/j.issn.1671-7554.0.2022.0415
田吉光,王志勇,程林,桑锡光
TIAN Jiguang, WANG Zhiyong, CHENG Lin, SANG Xiguang
摘要： 目的 设计一种新式骨盆及髋臼通道螺钉的置钉方法,根据该方法设计相应装置并进行人体标本研究,以判断该方法的置钉效果。 方法 本研究以CT影像数据为基础,利用投影原理和方向分解的方法,准确定位钉道入钉点及入钉方向,并根据以上理论设计制作了一套专用定位架。术前将定位架固定到人体骨盆标本上并进行CT扫描以获得数据,利用CT分析软件规划钉道,再通过方向分解的方法测得所需定位参数,术中在定位架上做出相应的调整,即可准确定位钉道。 结果 利用上述方法,成功进行骶髂螺钉、LC II螺钉、顺行前柱螺钉的置入。CT重建结果显示,术后钉道位置与术前规划位置高度一致,术后X线检查显示结果符合临床要求。 结论 本方法可准确定位骨盆及髋臼通道螺钉的空间位置,极大提高了手术的准确性。本方法原理简单,易于学习和操作,且价格低廉,易于在广大基层医院中普及,为骨盆及髋臼的微创治疗提供新的有效手段。
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| [1] Hung CC, Wu JL, Li YT, et al. Minimally invasive treatment for anterior pelvic ring injuries with modified pedicle screw-rod fixation: a retrospective study[J]. J Orthop Surg Res, 2018, 13(1): 238. [2] Corrêa WO, Batista VGR, Cavalcante EF Júnior, et al. Mortality predictors in patients with pelvic fractures from blunt trauma[J]. Rev Col Bras Cir, 2017, 44(3): 222-230. [3] Coccolini F, Stahel PF, Montori G, et al. Pelvic trauma: WSES classification and guidelines[J]. World J Emerg Surg, 2017, 12: 5. doi: 10.1186/s13017-017-0117-6. [4] Qoreishi M, Seyyed Hosseinzadeh HR, Safdari F. Clinical results of percutaneous fixation of pelvic and acetabular fractures: a minimally invasive internal fixation technique[J]. Arch Bone Jt Surg, 2019, 7(3): 284-290. [5] Guimarães JAM, Martin MP, Silva FR, et al. The obturator oblique and iliac oblique/outlet views predict most accurately the adequate position of an anterior column acetabular screw[J]. Int Orthop, 2019, 43(5): 1205-1213. [6] He DD, Deng CY, He XY, et al. Intraoperative assisted O-arm navigation imaging for unstable pelvic fractures in INFIX[J]. Zhongguo Gu Shang, 2022, 35(4): 317-322. [7] Hiyama A, Ukai T, Nomura S, et al. The combination of intraoperative CT navigation and C-arm fluoroscopy for INFIX and percutaneous TITS screw placement in the treatment of pelvic ring injury: technical note[J]. J Orthop Surg Res, 2022, 17(1): 32. [8] Verhey JT, Haglin JM, Verhey EM, et al. Virtual, augmented, and mixed reality applications in orthopedic surgery[J]. Int J Med Robot, 2020, 16(2): e2067. [9] Wong JM, Bewsher S, Yew J, et al. Fluoroscopically assisted computer navigation enables accurate percutaneous screw placement for pelvic and acetabular fracture fixation[J]. Injury, 2015, 46(6): 1064-1068. [10] Marmor M, Lynch T, Matityahu A. Superior gluteal artery injury during iliosacral screw placement due to aberrant anatomy[J]. Orthopedics, 2010, 33(2): 117-120. [11] Lichte P, Alabdulrhaman H, Pishnamaz M, et al. Perkutane Schraubentechniken an Beckenring und Acetabulum Percutaneous screwtechniques for the pelvic ring and acetabulum[J]. Unfallchirurg, 2019, 122(5): 387-403. [12] Pavelka T, Salášek M, Weisová D. Complications associated with surgical treatment of pelvic ring fractures[J]. Acta Chir Orthop Traumatol Cech, 2013, 80(3): 208-215. [13] Pinto A, Niola R, Tortora G, et al. Role of multidetector-row CT in assessing the source of arterial haemorrhage in patients with pelvic vascular trauma. Comparison with angiography[J]. Radiol Med, 2010, 115(4): 648-667. [14] Chen HW, Liu GD, Fei J, et al. Treatment of unstable posterior pelvic ring fracture with percutaneous reconstruction plate and percutaneous sacroiliac screws: a comparative study[J]. J Orthop Sci, 2012, 17(5): 580-587. [15] Chen H, Ding C, Liu Y, et al. A clinical and biomechanical comparison of INFIX plus single versus double sacroiliac screw fixation for unstable pelvic ring injury[J]. J Orthop Surg Res, 2022, 17(1): 285. [16] Sagi HC, Lindvall EM. Inadvertent intraforaminal iliosacral screw placement despite apparent appropriate positioning on intraoperative fluoroscopy[J]. J Orthop Trauma, 2005, 19(2): 130-133. [17] Thakkar SC, Thakkar RS, Sirisreetreerux N, et al. 2D versus 3D fluoroscopy-based navigation in posterior pelvic fixation: review of the literature on current technology[J]. Int J Comput Assist Radiol Surg, 2017, 12(1): 69-76. [18] Ciolli G, Caviglia D, Vitiello C, et al. Navigated percutaneous screw fixation of the pelvis with O-arm 2: two years' experience[J]. Med Glas(Zenica), 2021, 18(1): 309-315. [19] Verbeek J, Hermans E, van Vugt A, et al. Correct positioning of percutaneous iliosacral screws with computer-navigated versus fluoroscopically guided surgery in traumatic pelvic ring fractures[J]. J Orthop Trauma, 2016, 30(6): 331-335. [20] 翟志凯, 张国梁. 计算机辅助技术在骨科手术中的应用进展[J]. 机器人外科学杂志(中英文), 2021, 2(6): 485-491. ZHAI Zhikai, ZHANG Guoliang. Advances of computer-assisted technology in orthopedic surgery[J]. Chinese Journal of Robotic Surgery, 2021, 2(6): 485-491. [21] 李宇能, 刘昊楠, 赵春鹏, 等. 急诊骨科手术机器人辅助经皮固定骶髂关节螺钉治疗不稳定型骨盆后环骨折的临床研究[J]. 中华创伤骨科杂志, 2022, 24(3): 194-199. LI Yuneng, LIU Haonan, ZHAO Chunpeng, et al. Emergency iliosacral screw fixation assisted by TiRobot for unstable posterior pelvic ring fracture[J]. Chinese Journal of Orthopaedic Trauma, 2022, 24(3): 194-199. [22] Han W, Zhang T, Su YG, et al. Percutaneous robot-assisted versus freehand S2 iliosacral screw fixation in unstable posterior pelvic ring fracture[J]. Orthop Surg, 2022,14(2): 221-228. [23] Schuijt HJ, Hundersmarck D, Smeeing DPJ, et al. Robot-assisted fracture fixation in orthopaedic trauma surgery: a systematic review[J]. OTA Int, 2021, 4(4): e153. [24] 谭培勇, 项舟, 宋彬, 等. 数字化仿真技术确定最佳骶髂螺钉通道的研究[J]. 中国脊柱脊髓杂志, 2012, 22(7): 634-640. TAN Peiyong, XIANG Zhou, SONG Bin, et al. Digital virtual technique in determining the optimal sacroiliac screw channel[J]. Chinese Journal of Spine and Spinal Cord, 2012, 22(7): 634-640. [25] 陈练, 王旻晨, 杨亚安, 等. CT辅助导航经皮骶髂螺钉内固定路径[J]. 中国临床解剖学杂志, 2009, 27(1): 52-55. CHEN Lian, WANG Minchen, YANG Yaan, et al. An approach of percutaneous sacroiliac screw fixation guided by CT[J]. Chinese Journal of Clinical Anatomy, 2009, 27(1): 52-55. |
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