导航下空心螺钉内固定治疗老年人骶髂复合体损伤

摘要

目的 探讨导航下空心螺钉内固定治疗老年人骶髂复合体损伤的临床疗效及注意事项. 方法 2015年3月至2016年5月,我院采用导航下经皮空心螺钉内固定治疗21例老年骶髂复合体损伤患者,其中男14例,女7例;年龄60～73岁,平均(63.5±3.7)岁;车祸伤15例,高处坠落伤5例,其他伤1例.骨盆骨折按Tile分型:B型8例,其中B2型2例,B3型6例;C型13例,其中C1型5例,C2型6例,C3型2例.记录术中观察指标、置钉神经、血管损伤情况,术后应用Matta放射学评定标准评价骨折的复位质量,末次随访时采用Majeed评分标准进行骨盆功能评定. 结果 21例老年患者在导航辅助下共置入30枚空心螺钉,每枚螺钉置入时间为36～45 min,平均(40.5±4.7) min,术中置入每枚螺钉出血10～20 ml;术后复查发现1例患者螺钉穿出S1椎体前缘骨皮质,1例患者螺钉尾部垫圈陷入髂骨外板,未突破髂骨内板,但2例患者术后均无并发症;其余螺钉位置均良好,无神经、血管损伤及其他并发症出现.术后复位质量依据Matta放射学评定:优14例,良5例,可2例,差0例,优良率为90.5％.19例老年患者术后获得7～13个月,平均(10.3±2.1)个月随访,其中1例患者术后3个月复查时发现双侧骶髂关节螺钉向外侧脱出约5 mm,但在后期随访中患者功能良好,螺钉无继续脱出;余18例患者末次随访时复查骨盆X线片、CT结果显示骨折愈合良好,无螺钉脱出、断裂及松动情况发生,同时依据Majeed标准对骨盆功能进行评定:优9例,良10例,优良率为90.5％. 结论 导航下空心螺钉内固定治疗老年性骶髂复合体损伤具有创伤小,置钉精确、安全、固定有效等特点,但老年人骨质较为疏松,在置钉过程中应注意.%Objective To investigate the therapeutic effects of navigation-guided hollow screw fixation on the treatment of elderly patients with the sacroiliac complex injury.Methods Twentyone older patients with sacroiliac complex injury received the three-dimensional images-guided percutaneous hollow screw fixation from March 2015 to May 2016.There were 14 males and 7 females with age of 60-73 years[average(63.5 ± 3.7) years].Traffic accident injury was found in 15 cases,falling injury in 5 cases,others in one case.The pelvic fractures were classified by tile classification:type B2 in 2 cases,type B3 in 6 cases,type C1 in 5 cases,type C2 in 6 cases,type C3 in 2 cases.Intraoperative observation data,the injury of nerve and blood vessel during the screw insertion,postoperative fracture reposition and so on were recorded.The quality of fracture reposition was evaluated by Matta radiological criteria after surgery,and the pelvic function was assessed by Majeed scoring criteria at the last follow-up.Results A total of 30 hollow screws in 21 elderly patients were placed under three-dimensional images navigation,and each screw fixation time was 36-45 min,average (40.5±4.7)min with a small amount of bleeding (10-20)ml.Postoperative examinations showed that S1 vertebral cortical bone screw wear was found in one patient,and the end of the bolt washer was internalized into the outer table of the ilium without breaking the medial iliac plate in another patient.The above two patients had no postoperative complications.Other screws positions were good,without nerve or vascular injury and other complications.Postoperative reposition quality evaluated by the Matta radiological criteria showed that 14 cases had excellent quality,five with good quality,two with fair quality,and no case with poor quality.Therefore,the excellent and good rates were 90.5 ％.Moreover,19 elderly patients were followed up for 7-13 months average(10.3± 2.1)months,and only one patient showed the bilateral sacroiliac joint screws outside the lateral sacroiliac joint 5 mm.However,this patient had good function in the later follow-up without further prolapse.The remaining 18 patients assessed by the pelvic X-ray and CT at the end of the follow-up showed a good fracture healing,no screw breakage,loosening,and prolapse.Meanwhile,pelvic function findings evaluated by the Majeed standard demonstrated that nine cases were with excellent function,ten with good function,and the excellent and good rates were 90.5％.Conclusions Three-dimensional images-guided hollow screw fixation for the treatment of elderly patients with the sacroiliac complex injury is safe and effective with less trauma and high nailing accurateness.However,the placing process should be cautious in the elderly with osteoporosis.