后路微创钢板与三维导航经皮骶髂螺钉内固定治疗老年人骨盆后环骨折的比较研究

中华创伤杂志 Pub Date : 2020-01-15 DOI:10.3760/CMA.J.ISSN.1001-8050.2020.01.008

Xiao-zhen Wang, Guodong Wang, Gang Wu, Ximing Liu, Xianhua Cai, Hu Song

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The operation time, intraoperative blood loss, X-ray exposure time, complication rate and postoperative visual analogue scale (VAS) were compared between the two groups. Postoperative Matta radiographic criteria was used to assess fracture reduction quality, and Majeed criteria was used to assess pelvic function at the last follow-up. \n \n \nResults \nAll 75 patients were followed up for 6-24 months (mean, 13.5 months). The operation time, intraoperative blood loss and X-ray exposure time in the plate group were (126.1±20.6)minutes, (251.6±50.8)ml, and (15.7±4.4)s, showing significant differences in comparison with the navigation groups [(49.7±17.5)minutes, (22.8±5.1)ml, and (112.8±8.8)s](P 0.05). At day 3, one week, and one month postoperatively, the VAS in the navigation group was (3.3±0.7)points, (3.2±0.7)points, (2.4±0.6)points, better than that in the plate group [(7.2±0.7)points, (6.2±0.8)points and (4.5±0.7)points] (P 0.05). 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引用次数: 0

摘要

目的比较后路微创重建钢板与三维导航经皮骶髂螺钉内固定治疗老年骨盆后环骨折的临床疗效。方法回顾性分析2014年1月至2018年6月在解放军中心医院收治的75例老年骨盆后环骨折患者的临床资料。男32例，女43例，年龄60-83岁（平均67.7岁）。钢板组24例采用后路微创重建钢板内固定，导航组51例采用三维导航经皮骶髂螺钉内固定。比较两组的手术时间、术中出血量、X线照射时间、并发症发生率和术后视觉模拟评分（VAS）。术后Matta放射学标准用于评估骨折复位质量，Majeed标准用于评估最后一次随访时的骨盆功能。结果75例患者随访6～24个月，平均13.5个月。钢板组的手术时间、术中出血量和X光暴露时间分别为（126.1±20.6）分钟、（251.6±50.8）ml和（15.7±4.4）s，与导航组[（49.7±17.5）分钟、，（3.2±0.7）分、（2.4±0.6）分，优于钢板组[（7.2±0.7）点、（6.2±0.8）点和（4.5±0.7）]（P 0.05）。根据Matta放射学标准，钢板组优良率为92%（优14例，良8例，尚可2例），导航组为82%（优25例，良17例，尚可9例）。两组比较无显著性差异（P>0.05），随访时按Majeed标准，钢板组优良率96%（优15例，良8例，尚可1例），导航组优良率94%（优35例，良13例，尚可3例）。结论对于老年骨质疏松性骨盆后环骨折患者，三维导航下经皮骶髂螺钉内固定与微创重建钢板内固定相比，具有手术时间短、出血少、放射剂量小、术后疼痛小的优点，因此值得临床应用。关键词：老年；骨盆；骨折内固定术；骨质疏松症；手术，计算机辅助

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Comparative study of posterior minimally invasive plate and 3D-navigated percutaneous sacroiliac screw internal fixation for treatment of posterior pelvic ring fracture in elderly patients

Objective To compare the clinical efficacy of posterior minimally invasive reconstruction plate and 3D-navigated percutaneous sacroiliac screw fixation of elderly patients with posterior pelvic ring fractures. Methods A retrospective cases control study was performed to analyze the data of 75 elderly patients with posterior pelvic ring fractures admitted from January 2014 to June 2018 in Central Hospital of the PLA. There were 32 males and 43 females, with the age range of 60-83 years (mean, 67.7 years). Twenty-four patients in the plate group were treated by posterior minimally invasive reconstruction plate fixation, and 51 patients in the navigation group were treated by percutaneous sacroiliac screw internal fixation with 3D navigation. The operation time, intraoperative blood loss, X-ray exposure time, complication rate and postoperative visual analogue scale (VAS) were compared between the two groups. Postoperative Matta radiographic criteria was used to assess fracture reduction quality, and Majeed criteria was used to assess pelvic function at the last follow-up. Results All 75 patients were followed up for 6-24 months (mean, 13.5 months). The operation time, intraoperative blood loss and X-ray exposure time in the plate group were (126.1±20.6)minutes, (251.6±50.8)ml, and (15.7±4.4)s, showing significant differences in comparison with the navigation groups [(49.7±17.5)minutes, (22.8±5.1)ml, and (112.8±8.8)s](P 0.05). At day 3, one week, and one month postoperatively, the VAS in the navigation group was (3.3±0.7)points, (3.2±0.7)points, (2.4±0.6)points, better than that in the plate group [(7.2±0.7)points, (6.2±0.8)points and (4.5±0.7)points] (P 0.05). According to the Matta radiographic criteria, the excellent and good rate was 92% in plate group (excellent in 14 cases, good in 8, and fair in 2), and was 82% in the navigation group (excellent in 25 cases, good in 17 and fair in 9). There was no significant difference between the two groups (P>0.05). According to the Majeed criteria at the follow-up, the excellent and good rate was 96% in the plate group (excellent in 15 cases, good in 8 and fair in 1), and was 94% in the navigation group (excellent in 35 cases, good in 13 and fair in 3). The difference between the two groups was not statistically significant (P>0.05). Conclusion For elderly patients with osteoporotic posterior pelvic ring fractures, percutaneous sacroiliac screw fixation under 3D navigation has the advantages of shorter operation time, less bleeding, less radiation dose and less postoperative pain than minimally invasive reconstruction plate internal fixation, and hence deserves clinical application. Key words: Aged; Pelvis; Fracture fixation, internal; Osteoporosis; Surgery, computer aided

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来源期刊

中华创伤杂志

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11327

期刊介绍： Chinese Journal of Trauma (International Standard Serial Publication Number: ISSN 1001-8050, Domestic Uniform Serial Publication Number: CN 50-1098/R) was founded in September 1985, which is the only high-level medical professional academic journal that can comprehensively and systematically reflect the achievements and development trends of China's traumatology medicine, and has a wide academic influence in China's traumatology medicine community. It has a wide range of academic influence in China's trauma medicine. Chinese Journal of Trauma is a source journal of China Science and Technology Paper Statistics, a source journal of China Science Citation Database (CSCD), a core journal of China Comprehensive Medicine and Health Care, a source journal of China Academic Journals Comprehensive Evaluation Database (CAJCED), a full-text journal of China Journal Full-text Database (CJFD), a core academic journal of China Center for Scientific Evaluation (RCCSE), a core academic journal of China Traumatology and Traumatology Center (CTC), a core academic journal of China Traumatology Center (RCCSE). RCCSE) core academic journals; Chinese Biomedical Journal Database (CMCC), Chinese Biomedical Journal Citation Database (CBJCED), China Journal Network (CJN), China Academic Journals (CD-ROM), Chinese Academic Journals Abstracts (Chinese Edition), Chemical Abstracts of the United States (CA), Index Copernicus of Poland (IC), and Japan Institute of Science and Technology Database (JICST), World Health Organization Western Pacific Region Medical Search (WPRIM) and Russian Journal of Abstracts (ΡЖ) included journals.