| Objective The aim of this study is to measure the anatomic parameters of the anterior acetabular column screw.Then discuss the clinical efficacy of minimally invasive retrograde anterior acetabular column screw,so as to provide a precise and safe assistance for the screw placement.Methods Part one:Pelvic CT scan data were collected from 30 adults(15 males and 15 females without any body problem)sundergoing CT scan in our hospital from June 2015 to January 2016.The virtual three-dimensional model were reconstructed by software Mimics and the virtual screw were retrograde placed both in left and right anterior acetabular column.The length,insert direction,insert point of the screws were measured.Then 35 cross-sections of the anterior acetabular column were created by the software and the diameter of the screw tunnel were measured.Part two:a retrospective analysis was made on 25 cases of acetabular fractures involving the anterior column from January2015 to 2016 March.They were 17 men and 8women,from 21 to 66 years of age.12 of them used navigation combined with 3D digital programming(group A),including 9 men and 3 women,with an average age of 38.3 ± 12.1 years.The other 13 cases only usednavigation(group B),including 8 men and 5 women,with an average age of 40.1 ± 13.8 years.The virtual three-dimensional model were reconstructed of group A and the virtual screw were retrograde inserted to uninjured side by software Mimics.Then,the insert direction,insert point of the screws and the minimum diameter of the screw tunnel were measured,providing reference data for surgery.All patients were treated by percutaneous screw fixation of acetabular anterior column fractures under image-based computer navigation.The two groups were compared for time of anterior column screw insertion,intraoperative bleeding,intraoperative fluoroscopy frequency,fracture reduction and Majeed scores.Results Part one:The mean maximum length of virtual screw was(119.79±8.71)mm for the male and it was(104.10±5.84)for the female.The perpendicular distances from the insert point to the rim of superior ramus and pubic symphyses were(19.69±2.79)mm?(18.80±3.35)mm for the male and they were(18.27±2.13)mm?(22.92±3.34)mm for the female.The angle to the coronal plane,sagittal plane and transverse plane were(16.18±5.37)°?(41.76±4.78)°and(43.30±5.55)°for the male and they were(17.16±5.53)°?(43.12±3.90)°and(41.36±4.59)°for the female.There were significant differences between the male and female in the length and PB(P<0.05).There were no significant differences between the male and female in insert direction and PA(P>0.05).The narrowest cross-section of the screw tunnel was located at the 5th layer.The diameter of screw tunnel in the 5th cross section was(11.43±1.24)mm for the male and(8.75±0.95)mm for the female.They were significant differences between the male and female in the diameter of screw tunnel.Part two: All patients were followed up for an average of 7.8 months(range,from 3 to 12 months).There were no significant differences between the group A and group B in intraoperative bleeding(14.1± 2.6 ml;15.4 ± 2.0 ml),the good to excellent rate of reduction(83.3%;84.6%),the good to excellent rate of Majeed scores(91.7%;84.6%)(P>0.05).The time of anterior column screw insertion(22.2± 3.1)min and the intraoperative fluoroscopy frequency(24.8 ±3.4)times in group A were significantly less than those(28.8 ±4.2 min;30.8 ± 5.2 times)in group B(P<0.05).Conclusion With the help of digital technology in Department of orthopedics,we can shorten learning curve and reduce screw placement time and fluoroscopy times of minimally invasive retrograde anterior acetabular column screw.The technology provides a personalized treatment plan for the patient and it is an effective adjuvant technique for the screw fixation for acetabulum anterior column. |
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