3D打印导航内固定技术术前设计钉道位置在股骨颈骨折治疗中的应用  

Application of 3D Printing Navigation Internal Fixation for Femoral Neck Fracture

作　　者：顾洋 陈瑾 朱嘉俊 张凡棋 高一淋 徐中华[2] 汤立[2] GU Yang;CHEN Jin;ZHU Xijun(Xuzhou First People's Hospital, Jiangsu Xuzhou 221400, China)

机构地区：[1]江苏省徐州市第一人民医院骨科,江苏徐州221400 [2]江苏大学附属金坛医院骨科,江苏金坛213200

出　　处：《河北医学》2020年第2期320-325,共6页Hebei Medicine

基　　金：江苏省卫生厅医改试点单位科研课题项目，(编号:YG201310)

摘　　要：目的:应用3D打印导航内固定技术,在术前设计针对股骨颈骨折患者的空心钉内固定钉道及手术导航器,探讨其的应用价值。方法:将2015年1月至2017年6月我院收治的86例股骨颈骨折患者随机均分为观察组和对照组,各43例,均接受闭合复位空心钉内固定治疗,对照组采用常规手术方案;观察组在术前应用3D打印技术设计钉道并制作导航模块,辅助完成内固定手术。对比两组手术基本指标、螺钉分布情况,术后3个月、12个月Harris髋关节功能评分及随访末期骨折愈合情况。结果:观察组入院至手术时间、手术时间明显长于对照组,术中出血量明显多于对照组,透视次数及穿钉次数明显少于对照组,差异均有统计学意义(P<0.05)。观察组正位及侧位螺钉相互平行度明显低于对照组,螺钉分布面积比明显高于对照组,差异有统计学意义(P<0.05)。观察组下床时间明显短于对照组,差异有统计学意义(P<0.05)。观察组术后3个月Harris髋关节功能分级明显好于对照组,差异有统计学意义(P<0.05)。两组随访末期骨折不愈合、股骨头坏死发生率、Garden对位指数及术后12个月时Harris评分分级对比,差异无统计学意义(P>0.05)。结论:3D打印导航内固定技术术前设计钉道位置能够有效指导股骨颈骨折空心钉固定术的开展,能够减少透视及穿钉次数,且不会增加不良预后风险,同时有助于患者尽早开展功能锻炼。Objective:To design the hollow nail internal fixation channel and operation navigation device for the patients with femoral neck fracture before operation,and discussed its application value by 3D printing navigation internal fixation technology.Methods:86 cases with femoral neck fracture admitted in our hospital from January 2015 to June 2017 were randomly divided into the observation group and the control group,with 43 cases in each group.All cases were treated with closed reduction and cannulated screw internal fixation.Patients in the control group received routine operation scheme,while for patients in the observation group,nail path position and navigator were designed by preoperative 3D printing navigation fixation technology.The basic indexes of surgery,postoperative screw distribution,Harris hip function score at 3 and 12 months after surgery,fracture healing status at the end following-up were observed and compared in 2 groups.Results:The duration from admitting to surgery and the duration of surgery in the observation group were much longer than those in the control group,the amount of bleeding during surgery in the observation group was much more than that in the control group,the times of fluoroscopy and of nail piercing in the observation group were much less than those in the control group,the differences were statistically significant(P<0.05).The parallel degree of screws at front and side in the observation group were significantly lower than that in the control group,and the ratio of screw distribution area in the observation group was significantly higher than that in the control group(P<0.05).At 3 months after operation,the Harris hip function score in the observation group was much better than it in the control group(P<0.05).There were no significant differences in Harris hip function score between the two groups at 12 months after operation(P>0.05).There was no significant difference in incidence of fracture nonunion,femoral head necrosis,Garden indexes and Harris hip function score at the e

关 键 词：股骨颈骨折 3D打印 手术导航 骨折内固定术 

分 类 号：R687.3[医药卫生—骨科学]