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Objective:To investigate the clinical significance of excessive inlet view in fluoroscopy-assisted placement of sacroiliac screws.Methods:Included for this prospective study were 47 patients with unstable pelvic fracture who had been admitted to Department of Orthopaedic Trauma, Xi'an Honghui Hospital between January 2020 and January 2021. There were 30 males and 17 females, with a mean age of 39.4 years (from 25 to 66 years). By the Tile classification, 21 fractures were type B and 26 ones type C. The inlet view and the angle of excessive inlet view were measured before operation. The intraoperative placement of sacroiliac screws was assisted by C-arm fluoroscopy navigation in the excessive inlet view. The positions of sacroiliac screws were verified by CT or O-arm fluoroscopy after operation. The screw placement time, fracture reduction quality, fracture healing time, and pelvic function at the last follow-up were recorded.Results:A total of 67 screws were implanted in the 47 patients, including 56 sacroiliac screws. The insertion time for each screw averaged 19.9 min (from 9 to 31 min); the angle of excessive inlet view averaged 17.38° (from 12.1° to 24.8°). Verification by O-arm fluoroscopy or CT revealed that all sacroiliac screws were located in the sacral canal without dislocation or breaking through the cortical bone. By the postoperative Matta scoring, the reduction was excellent in 22 cases, good in 17, acceptable in 6, and poor in 2, giving an excellent to good rate of 83.0%(39/47). The average follow-up time for the 47 patients was 9.5 months (from 5 to 15 months); fracture healing time averaged 10.5 weeks (from 7 to 16 weeks). By the Mejeed scoring at the last follow-up, the pelvic function was excellent in 26 cases, good in 15 and acceptable in 6, giving an excellent to good rate of 87.2% (41/47).Conclusions:Fluoroscopy in the excessive inlet view is a simple and easy intraoperative technique. It can improve accuracy and safety of sacroiliac screw placement because it allows clear identification of the posterior border of the sacrum and effectively avoids iatrogenic injury to the sacral nerve caused by screws breaking through the bone cortex.
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BACKGROUND: Core decompression and bone grafting is the main postoperative method in the treatment of ARCO stage II non-invasive necrosis of the femoral head, but there are risks of inaccurate location, incomplete or excessive removal of necrotic bone. OBJECTIVE: To observe the accuracy and safety of three-dimensional(3 D) printed navigation template assisted core decompression and bone grafting in the treatment of ARCO stage II non-traumatic femoral head necrosis. METHODS: Eighty patients(96 hips) of ARCO stage II non-traumatic femoral head necrosis were enrolled from January to November 2017 in Honghui Hospital Affiliated to Xi’an Jiaotong University. The patients were randomly divided into two groups. In the 3 D group, 40 cases(48 hips) received 3 D printed navigation template assisted core decompression and bone grafting. In the control group, 40 cases(48 hips) received core decompression and bone grafting(no navigation template). All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. The operation time, intraoperative fluoroscopy, and intraoperative blood loss were recorded, and X-ray examination results at 3, 6, 12, and 24 months after operation were observed. The femoral head survival rate, hip Harris score, and pain visual analogue scale score were evaluated. The efficacy was compared. RESULTS AND CONCLUSION:(1) Compared with the control group, the operation time was shortened from(132.57±14.86) minutes to(82.63±10.31) minutes; the number of intraoperative fluoroscopy was reduced from(16.80±2.15) times to(4.93±1.36) times; blood loss was reduced from(143.23±17.98) mL to(75.64± 16.23) mL in the 3 D group. Operation time, number of fluoroscopy, and blood loss were superior in the 3 D group than in the control group(P < 0.05).(2) The 24-month follow-up of imaging showed that only 2 cases of the femoral head collapsed in the 3 D group, but the hip joint function was acceptable. There was no artificial hip arthroplasty and the femoral head survival rate was 96%. In the control group, femoral head collapsed in 9 cases. Four of them had total hip arthroplasty due to limited hip joint activity, and the femoral head survival rate was 81%. The survival rate of the femoral head in the 3 D group was higher than that in the control group(P=0.024).(3) Compared with the control group, Harris score and visual analogue scale score were improved in the 3 D group(P < 0.05).(4) Applying 3 D printed navigation template to core decompression and bone grafting for ARCO stage II non-traumatic femoral head necrosis can reduce the operation time, intraoperative fluoroscopy and blood loss, and improve the accuracy and safety of intraoperative positioning.