Objective: To investigate the advantages and effectiveness of ISO-C3D guided percutaneous sacroiliac joint screw internal fixation for treatment of pelvic posterior ring injuries by comparing with anterior opened reduction and reconstruction plate internal fixation.
Methods: A retrospective analysis was made on the clinical data of 54 patients with posterior ring injury treated between June 2013 and January 2016. Of 54 patients, 33 underwent ISO-C3D guided percutaneous sacroiliac joint screws internal fixation (group A), and 21 underwent anterior opened reduction and reconstruction plate internal fixation (group B). There was no significant difference in gender, age, cause of injuries, injury to operation time, fractures type, combined injuries, and injury severity score (ISS) between 2 groups (P>0.05). The operation time, intraoperative blood loss, length of operative incision, hospitalization time, postoperative pain degree, reduction evaluation, and functional evaluation were compared between 2 groups.
Results: Group A was significantly better than group B in operation time, length of operative incision, and hospitalization time (P<0.05). The intraoperative blood loss of group A (10-20 mL) was significantly less than that of group B[(524.1±160.1) mL]. All patients of the 2 groups were followed up 7 to 24 months with an average of 11.6 months. No injury of vessel or nerve occurred in group A; worse neurological symptoms of lower limbs and incision infection were observed in 2 patients of group B respectively, and the other patients achieved primary healing of incision. At 48 hours after operation, the visual analogue scale (VAS) score of group A (1.7±0.7) was significantly lower than that of group B (8.2±0.8) (t=-30.463, P=0.000). Radiological examination showed fracture reduction. According to the Matta score standard, the reduction results were excellent in 21 cases (63.6%), good in 10 cases (30.3%), and fair in 2 cases (6.1%) in group A; the reduction results were excellent in 16 cases (76.2%), good in 4 cases (19.1%), and fair in 1 case (4.7%) in group B; and there was no significant difference between 2 groups (χ2=0.961, P=0.618). Fracture or dislocation healed well in 2 groups, and the walking function was restored. According to the Majeed standard for evaluation, the results were excellent in 23 cases (69.7%), good in 9 cases (27.3%), and fair in 1 case (3.0%) in group A; the results were excellent in 14 cases (66.7%), good in 5 cases (23.8%), and fair in 2 cases (9.5%) in group B; no significant difference was shown between 2 groups (χ2=1.501, P=0.591).
Conclusions: Compared with anterior opened reduction and reconstruction plate internal fixation, ISO-C3D navigation percutaneous sacroiliac joint screw internal fixation is an ideal surgical method to treat pelvic posterior ring injury, with the characteristics of less trauma, less pain, precise screw implant and safety.
目的: 通过与前路切开复位重建接骨板内固定比较，探讨ISO-C3D导航下经皮骶髂关节螺钉内固定治疗骨盆后环损伤的优势及疗效。.
方法: 回顾分析2013年6月-2016年1月收治的54例骨盆后环损伤患者临床资料，其中33例采用ISO-C3D导航下经皮骶髂关节螺钉内固定（A组），21例采用前路切开复位重建接骨板内固定（B组）。两组患者性别、年龄、致伤原因、受伤至手术时间、骨折类型、合并伤以及创伤严重度评分（ISS）等一般资料比较，差异均无统计学意义（P＞0.05）。记录并比较两组手术时间、术中出血量、手术切口长度、住院时间、术后疼痛程度、骨折复位及功能恢复情况。.
结果: A组手术时间、手术切口长度、住院时间均优于B组，比较差异有统计学意义（P＜0.05）。A组术中出血量估算为10～20 mL，亦明显少于B组的（524.1±160.1）mL。两组患者均获随访，随访时间7～24个月，平均11.6个月。A组无1例出现神经、血管损伤；B组2例术后出现下肢神经症状加重，经对症处理后症状缓解。B组2例切口感染，经对症处理后愈合；其余患者切口均Ⅰ期愈合。术后48 h A组疼痛视觉模拟评分（VAS）为（1.7±0.7）分，显著低于B组的（8.2±0.8）分（t=-30.463，P=0.000）。影像学复查示，骨折复位根据Matta评分标准，A组优21例（63.6%）、良10例（30.3%）、可2例（6.1%）；B组优16例（76.2%）、良4例（19.1%）、可1例（4.7%）；两组比较差异无统计学意义（χ2=0.961，P=0.618）。两组患者骨折或脱位愈合良好，并恢复行走功能。末次随访时，根据Majeed评分标准，A组获优23例（69.7%）、良9例（27.3%）、可1例（3.0%）；B组获优14例（66.7%）、良5例（23.8%）、可2例（9.5%）；两组比较差异无统计学意义（χ2=1.501，P=0.591）。.
结论: 与前路切开复位重建接骨板内固定相比，ISO-C3D导航下经皮骶髂关节螺钉内固定治疗骨盆后环损伤具有创伤小、疼痛轻、植钉精确、安全等特点，是一种理想的手术方法。.
Keywords: Fracture; Internal fixation; Navigation; Pelvic posterior ring injury; Reconstruction plate; Screw.