3D打印导板辅助置入空心钉治疗无移位型股骨颈骨折的短期评价  

A short-term evaluation of three-dimensional printed guide plate assisted hollow screw in the treatment of non-displaced femoral neck fracture

作　　者：王思哲 高海燕 蓝孝全 王盼 黄浩然 王金玉 马建林 Wang Sizhe;Gao Haiyan;Lan Xiaoquan;Wang Pan;Huang Haoran;Wang Jinyu;Ma Jianlin(Spine and Joint Surgery,Qingdao Chengyang People’s Hospital,Shandong First Medical University,Qingdao 266000,Shandong Province,China;Department of Imaging,Qingdao Chengyang People’s Hospital,Shandong First Medical University,Qingdao 266000,Shandong Province,China;3D Printing Medical Transformation Center,Qingdao Chengyang People’s Hospital,Shandong First Medical University,Qingdao 266000,Shandong Province,China)

机构地区：[1]山东第一医科大学附属青岛医院脊柱关节外科,山东省青岛市266000 [2]山东第一医科大学附属青岛医院影像科,山东省青岛市266000 [3]山东第一医科大学附属青岛医院3D打印医学转化中心,山东省青岛市266000

出　　处：《中国组织工程研究》2021年第36期5753-5758,共6页Chinese Journal of Tissue Engineering Research

基　　金：青岛市2020年度医药科研指导计划(2020-WJZD205),项目负责人:马建林。

摘　　要：背景:空心钉治疗股骨颈骨折为临床常见标准术式。借助3D打印制作的个性化手术工具中最为典型的就是手术置钉导板,借助导板的辅助不但可以降低螺钉穿破骨皮质的风险,而且与传统方法相比置钉更精准、高效。目的:探讨在3D打印导板辅助下置入空心钉治疗无移位型股骨颈骨折的短期临床效果。方法:回顾性分析2016年10月至2019年10月在山东第一医科大学附属青岛医院诊断为无移位型股骨颈骨折的患者共60例,手术方式均采用空心钉内固定治疗,根据是否采用3D打印分为研究组和对照组,每组30例。研究组采用3D打印导板辅助置钉,对照组采用传统导向器或徒手置钉。术后随访12个月,比较两组手术时间、术中透视次数、髋关节Harris评分、置钉在位率以及3枚空心钉距股骨颈皮质的距离。结果与结论:(1)所有入组病例均获得有效随访,均顺利完成手术,未出现血管神经损伤等并发症;(2)研究组的手术时间明显短于对照组,术中透视次数、空心钉距骨皮质最短距离均优于对照组,组间比较差异有显著性意义(P<0.05);(3)研究组的置钉在位率优于对照组,但组间差异无显著性意义(P>0.05);(4)两组间术后12个月随访Harris评分比较差异无显著性意义(P>0.05);(5)结果表明,3D打印导板辅助空心钉治疗无移位型股骨颈骨折在达到良好手术效果的同时,可以节省手术时间,减少术中透视次数,降低失血量,有利于优化空心钉的空间分布,防止退钉并提高固定强度,短期临床效果肯定。BACKGROUND:Hollow screw treatment of femoral neck fractures is a common standard clinical operation.Combined with three-dimensional(3 D)printing for surgical operations,the most typical one of the individualized surgical tools is the surgical guide plate.The guide plate not only can reduce the risk of screw penetration and cortical fracture,but also the screw placement is more accurate and efficient than traditional methods.OBJECTIVE:To explore the short-term clinical effects of hollow screws in the treatment of non-displaced femoral neck fractures with the assistance of 3 D printed guide plates.METHODS:A retrospective analysis of 60 patients diagnosed with non-displaced femoral neck fractures in Qingdao Chengyang People’s Hospital of Shandong First Medical University from October 2016 to October 2019 was conducted.The surgical methods were all treated with hollow screw internal fixation.The patients were divided into study group and control group according to whether 3 D printing was used or not(n=30 per group).The study group received 3 D printed guide plates to assist screw placement,and the control group received traditional guides or freehand screw placement.The postoperative follow-up was 12 months.The operation time,the number of intraoperative fluoroscopy,the Harris score,the screw placement rate,and the distance between the three hollow screws and the femoral neck cortex were compared between the two groups.RESULTS AND CONCLUSION:(1)All the enrolled cases were followed up effectively,and the operation was successfully completed without complications,such as vascular and nerve injury.(2)The operation time of the study group was significantly shorter than that of the control group.The number of intraoperative fluoroscopy and the shortest distance of the hollow screw talar cortex of study group were better than those of the control group.There was a significant difference between the two groups(P<0.05).(3)The occupancy rates of screw placement of the study group were better than those of the control group

关 键 词：股骨颈骨折 无移位型 空心钉 3D打印 导板 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]