目的:探讨计算机辅助导航技术在骨盆骨折治疗中的应用及相关术前术中注意事项.方法:2010年5月至12月,采用导航下经皮微创螺钉内固定方法治疗骨盆骨折16例,男12例,女4例;年龄20～54岁,平均37岁;车祸伤5例,重物压伤5例,高坠伤6例.单纯前环骨折1例,前后环均骨折15例,其中骶髂关节脱位6例,骶骨骨折9例(均未累及骶管).根据Tile分型:C型15例,B型1例.观察内容包括螺钉置入时间,螺钉置入准确率,术中失血量,神经、血管、脏器损伤情况,术后骨折复位情况等.导航下经皮微创螺钉固定方法包括骶髂螺钉固定、耻骨支空心钉固定、耻骨联合分离空心钉固定.16例患者中单纯骶髂螺钉固定4例;骶髂螺钉固定、耻骨支空心钉固定、耻骨联合分离空心钉固定2例;骶髂螺钉固定及耻骨支空心钉固定8例;单纯行耻骨支空心钉固定2例.结果:置入螺钉36枚,平均每枚螺钉置入时间约20 min,术中出血10～20 ml.术后骨盆X线片及三维CT显示,所有骨折良好复位,螺钉无错误置入.伤口均Ⅰ期愈合,无伤口感染及固定失败;术后均未出现神经、血管及其他脏器损伤.结论:导航下经皮微创螺钉内固定治疗骨盆骨折具有创伤小、术中失血少、手术并发症发生率低、固定可靠、无须输血等优点,能很好地重建骨盆环的稳定性,但是对术者的技术要求较高,应注意充分的术前准备.%Objective:To investigate the applications of fluoroscopy-based navigation in pelvic fractures and related surgical considerations. Methods:From May 2010 to December, 16 patients with pelvic fractures were treated with computerized navigation. There were 12 males and 4 females with an average age of 37 years (ranged from 20 to 54 years). Fractures were caused by traffic accident in 5 cases,crush injury in 5 cases and falling from height in 6 cases. Ba sed on the Tile classification, there were 15 cases of Tile C type and 1 case of Tile B type. In these patients, 4 patients were treated with sacroiliac screw fixation;2 patients were treated with sacroiliac screw fixation,screw fixation for pubic symphysis diastasis and pubic fractures; 8 patients were treated with sacroiliac screw fixation and screw fixation for pubic fractures;2 patients were treated with screw fixation for pubic fractures. The index such as screw inserting time,accurance of inserting screws,intra-operative blood losing, injuries of nerve,vascular and other organs,reduction conditions were observed. Results:A total of 36 screws were inserted. The average time was 20 min for each screw placement. The blood loss ranged from 10 to 20 ml. There were no wound infections , neurovascualr injuries and other organ injuries. The postoperative pelvic X-ray and three-dimensional CT showed that the fractures had good reduction and all the screws had good position. Conclusion: Percutaneous screw fixation of pelvic fractures with fluoroscopy-based navigation have advantages such as little trauma,less blood loss,little complication,reliable fixation and no blood transfusion, which can reconstruct the stability of the pelvic ring,but need adequate preoperative reperation and high requirements for the surgeon.
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