Effect of modified fluoroscopic monitoring in treatment of acetabular anterior column fractures with percutaneous retrograde screw fixation under computer-assisted 3D navigation / 中华创伤杂志

ABSTRACT

Objective:To investigate the effect of modified fluoroscopic monitoring in the treatment of acetabular anterior column fractures with percutaneous retrograde screw fixation under computer-assisted 3D navigation.Methods:A retrospective case series analysis was performed on the clinical data of 42 patients with acetabular anterior column fractures admitted to Central Theater Command General Hospital of PLA from December 2013 to December 2016. There were 24 males and 18 females, with the age of 20-61 years [(41.6±12.9)years]. All patients underwent percutaneous retrograde acetabular anterior column screw fixation under computer-assisted 3D navigation. A total of 61 screws were inserted. The observation indexes included the time for insertion of each screw, intraoperative bleeding volume, fluoroscopy time, coincidence rate between intraoperative fluoroscopy and postoperative imaging, and complications. The D'Aubigné-Postel system was used to evaluate the hip joint function at postoperative 6 months. Fracture healing and complications were detected at postoperative 12 months.Results:All patients were followed up for 9-18 months [(13.1±3.2)months]. Time for insertion of each screw was (18.7±4.8)min, intraoperative bleeding volume was (16.6±3.8)ml, fluoroscopy time was (25.3±10.9)s, and coincidence rate between intraoperative fluoroscopy and postoperative imaging was 100%. There were no complications such as neurovascular injury, thrombosis, wound infection, heterotopic ossification and long-term pain. Six months after operation, D'Aubigné-Postel function score was (10.7±0.9)points, significantly improved compared with preoperative (8.7±1.6)points ( P<0.05). Two patients (3 screws) had lower limb mobility and two patients (2 screws) had screw loosening. Conclusion:For acetabular anterior column fractures, percutaneous retrograde acetabular anterior column screw placement assisted by 3D navigation is helpful to improve the accuracy of screw insertion, decrease introperative fluoroscopy time, reduce operation risk, improve screw coincidence rate, and therefore improve hip function.