| Objective Firstly,comparing and analyzing the parameters of the patient's contralateral S1 virtual nail path and the real nail path parameters under the ipsilateral 3D navigation through digital measurement,providing a safe and reliable indicator for clinical nail placement.Secondly,through clinical observation,the effect of Chinese medicine Jiegu-Qili tablet on the internal fixation of percutaneous screws under 3D navigation was determined.Methods Part one According to the inclusion and exclusion criteria,collected from January 2015 to July 2017,adult patients with unilateral sacroiliac complex injuris and three-dimensional navigation assisted percutaneous sacroiliac screw internal fixation were collected.20 cases of male and female were obtained from the preoperative pelvic CT scan.From the PACS system,we exported data in Dicom format,and then imported it into Mimics computer aided surgery software.We reconstructed pelvic 3D model by thresholding,region growing and so on.Instead of using virtual cylinder screws in the Medcad mode,the operation simulation of sacroiliac screws,respectively from the four limit entry points,direction into the screw(in the anterior superior iliac spine location at three o'clock,the posterior superior iliac spine located at nine o'clock.The up and down of the S1 were respectively twelve and six o'clock),and one the best nail point and direction.Part two,73 cases of sacroiliac complex injury treated by percutaneous insertion of S1 sacroiliac screw internal fixation with the aid of 3D navigation technique.Among them,there were 42 males and 31 females,with the age of 20-76 years(average of 39.90±10.84 years).Patients were randomly divided into A group(40 cases)and B group(33 cases).Group A was a 3D navigation and Jiegu-Qili tablet group,Group B was a simple 3D navigation group.The screw placement time,X-ray exposure time,screw breakthroughs and postoperative complications were recorded.Postoperative VAS(Visual Analogue Scale,VAS)scores were performed on both groups A and B.Comparison of postoperative fracture healing time.Postoperative Matta radiology criteria were used to evaluate the quality of fracture reduction,and the Majeed score was used to evaluate pelvic function at the last follow-up.Part three,preoperative collection of anatomical measurements and preoperative 40 cases patient data with unilateral hollow screw fixation assisted by three-dimensional navigation technology.Then,The first review of CT scan data were collected after operation.Data was derived from Dicom format in PACS system,and then imported into Mimics computer aided surgery software.The three-dimensional model of pelvic and sacroiliac joint screws were reconstructed by threshold segmentation and regional growth.Then,the spatial coordinates of the screws were read out,the direction of the needle was calculated,and the distance relationship between the nail points and the anterior iliac and posterior iliac spine were measured.Results Part one,the width of the narrowest pedicle of male and female S1 were respectively measured,(21.11±1.97)mm,(18.19±2.46)mm,and the height was(25.85±1.83)mm,(23.24±2.20)mm,the difference between the men and women in the width and height comparison has statistical significance(P<0.05).The distance between the posterior superior iliac spine and the best point of the insertion of the iliac spine were found by measuring the bone markers,male were(160.80±5.11)mm,(58.62±5.26)mm,and female were(154.38±7.80)mm,(54.35±6.03)mm.The vertical distance between male and female before and after the needle from the iliac spine line respectively were(10.17±1.63)mm,(4.46±3.14)mm,there was a statistically significant difference between male and female in the vertical distance between the anterior superior iliac spine and the posterior superior iliac spine,the placement of the pin point and the iliac anterior and posterior superior iliac spine(P<0.05).The dump head angle and abduction angle of the best pin point for the male and female before the operation are respectively,male,(8.43±1.48)°,(23.54±2.22)°,female,(4.77±1.31)°,(18.17±1.13)°,The differences between the angle were statistically significant(P<0.05).In the statistical process,the three o'clock and nine o'clock directions were taken as the abduction angle,thesix o'clock and twelve o'clock as the head dip.The male and female were three points,six points,nine points and twelve the angle of the angle respectively,male,(6.98±3.93)°,(17.77±7.23)°,(27.88±8.49)°,(5.97±3.10)°,female was(4.67±2.39)°,(20.67±5.60)°,(22.62±9.84)°,(6.10±3.02)°.There were statistically significant differences between male and female at six and nine points(P<0.05),and there was no significant difference between three points and twevle o'clock(P>0.05).Part two,A and B groups were co-placed with 99 hollow screws were inserted by three-dimensional navigation technology.In Group A,each screw was inserted and the intraoperative fluoroscopy time was(35.15±3.00)min and(1.80±2.34)s.The placement time and intraoperative fluoroscopy time of each screw in Group B were(34.70±2.92)min and(1.97±2.11)s,respectively,there was no significant difference between the two groups(P>0.05).The amount of bleeding was less in the operation and could not be calculated.In group A,3 patients who had symptoms of lumbosacral trunk injury before traction were treated with nutritional nerve for 3~6 months,and all recovered to normal.One patient with anterior pelvic ring fracture was treated with open reduction and internal fixation of the incision plate.The titanium plate was removed and reconstructed after debridement,vacuum sealing and drainage,and he recovered after one month.A and B group screws breakthroughs and screw withdrawal rates were 2%(1/50),4%(2/50),2.5%(1/40),2.5%(1/40).According to Matta radiological evaluation criteria the excellent and good rates of A and B two groups were 77.5%(31/40)and 78.8%(26/33).All patients were followed up for 7~18 months(average 10.6 months),respectively.The pelvic function was assessed by Majeed score standard at the last follow-up.The excellent rates of two groups in A and B were 92.5%(37/40)and 90.1%(30/33),respectively.There was no statistically significant difference between the two groups in the breakthrough rate of nailing,the rate of post operation screw withdrawal,the quality of reduction and the function score of the last follow-up(P>0.05).After operation,the average fracture healing time of group A was(10.11±0.74)weeks,and that of group B was(11.57±1.56)weeks,the difference between the two groups was statistically significant(P < 0.05).The VAS scores were evaluated preoperatively and postoperatively in both groups A and B,there was no significant difference between the two groups in preoperative scores(P>0.05).Patients in group A received oral Jiegu-Qili tablet on the first postoperative day.Differences between the two groups at first and third days after surgery were observed,there was statistical significance(P<0.05),The VAS scores were revisited seventh and thirtieth days after surgery,and there was no significant difference between the two groups(P>0.05).Part three,40 cases of unilateral sacroiliac complex injury patients,male and female screw head angles were measured(8.43±2.13)°,(5.10±1.67)°,abduction angle respectively,(22.94±2.81)°,(19.59±1.90)°,male and female in the chestdrainage abduction angle angle differences were statistically significant(P<0.05).In order to iliac anterior and posterior spine for bony landmarks,measuring position relationship between nail distance posterior iliac spine and iliac spine anterior and posterior the connection,by measuring the actual found that male and female screw from the posterior superior iliac spine respectively were(59.26±3.81)mm and(55.78±3.57)mm.At the same time,the vertical distance from the point to the anterior and posterior upper iliac spine is respectively,(10.30± 1.43)mm,(4.45±3.07)mm,the differences between the male and female were statistically significant(P<0.05).In the relationship between the pin point and the posterior superior iliac spine,the anterior and posterior upper spine line of the spine,the difference was not statistically significant(P>0.05).Conclusion Digital anatomic measurement combined with threedimensional navigation technology provided the direction of the insertion of S1 sacroiliac joint screw and the point with the reference point of bone reference.At the same time,the Chinese patent medicine Jiegu-Qili tablet with the effect of activating blood and removing blood stasis and relieving pain could obviously relieve the pain and promote the healing of fracture.In addition,there were individual differences in the parameters of the nail path,the plan should been made before the operation,and the individualized nail placement scheme was formulated so as to improve the safety and accuracy of the nail placement. |
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