Application of 3D image fusion technique of enhanced CT and magnetic resonance neurography on pelvic fractures with lumbosacral plexus injury / 中华骨科杂志

ABSTRACT

Objective:To investigate the application of three-dimensional (3D) image fusion technique of pelvic enhanced CT and magnetic resonance neurography (MRN) on the patients of pelvic fractures with lumbosacral plexus injury.Methods:From January 2019 to December 2020, 15 patients (11 males, 4 females, mean age 26.67±11.34 of pelvic fracture (AO classification C1.3 of 11 cases, C2 of 2 cases, C3 of 2 cases) with lumbosacral plexus injury underwent 3D image fusion of pelvic enhanced CT and MRN. All patients exhibited lower limb nerve dysfunction after injury. The preoperative muscle strength were evaluated by British Medical Research Council (BMRC) criteria grade 0 in 2 cases, grade 1 in 5, grade 2 in 7 and grade 3 in 1. Physical examination and enhanced CT combined with MRN 3D image fusion technology were used to accurately determine the injury site of lumbosacral plexus nerve, fracture displacement, and the direction of blood vessels and ureters, and develop corresponding surgical plans. The neurological functions were measured in post-operation follow-up.Results:All 15 operations were successfully completed and the site of lumbosacral plexus injury during operation was consistent with preoperative fusion image, and inconsistency of injury characteristic in 4 patients (4/15, 27%). Among the 6 cases of laparoscopic surgery, 2 cases were changed to open surgery because of the difficulty of nerve decompression. The average time of 4 cases of laparoscopic surgery was 116.27±26.46 min and intraoperative blood loss was 102.50±79.32 ml. The average time of 11 cases of open operation was 123.64±38.28 min, and intraoperative blood loss was 713.64±393.12 ml. For the opening operations, 9 cases were successfully decompressed, and nerve disruption was observed in 2 patients. All 15 patients were followed up. The average follow-up time was 9.33±2.19 months. The radial bony healing was observed in each case at the end of follow-up, mean healing time was 5.03±1.04 months (range, 3-6 months). In addition, patients' muscle strength recovered, 8 cases of grade 5, 3 cases of grade 4, 1 case of grade 3, 1 case of grade 2, and 2 cases of grade 0 after surgery. The difference was statistically significant ( Z=3.27, P<0.001). On the other hand, in sensory function assessment, there were 8 cases of grade S5, 1 case of grade S4, 3 cases of grade S3, 1 case of grade S2 and 2 cases of grade S0 after surgery. Conclusion:3D image fusion of enhanced CT and MRN can accurately locate and characterize pelvic fractures combined with lumbosacral plexus injury before surgery, accurately guide the formulation of surgical plan, and reduce surgical trauma and related complications.