3D打印定制钢板联合股骨近端防旋髓内钉在外侧壁粉碎的股骨转子间骨折中的应用  

Application of 3D⁃printing customized steel plate combined with PFNA for intertrochanteric fracture of femur with comminuted lateral wall

作　　者：孙振江 朱辉[2] 张国瑞 张艳亮[2] 翟艺宗 徐永申[2] SUN Zhenjiang;ZHU Hui;ZHANG Guorui;ZHANG Yanliang;ZHAI Yizong;XU Yongshen(Department of Orthopedics,the First Affiliated Hospital of He’nan University of Science and Technology,Luoyang 471000,China;不详)

机构地区：[1]河南科技大学临床医学院/河南科技大学第一附属医院骨科,河南洛阳471000 [2]河南科技大学第二附属医院骨科,河南洛阳471000

出　　处：《实用医学杂志》2023年第5期619-624,共6页The Journal of Practical Medicine

基　　金：河南省医学科技攻关计划项目(编号:LHGJ20200597)。

摘　　要：目的 探究3D打印(3DP)定制钢板联合股骨近端防旋髓内钉(PFNA)在外侧壁粉碎的股骨转子间骨折(IFF)中的应用价值。方法 选择2018年10月至2021年3月我院收治的108例外侧壁粉碎的IFF患者为研究对象。根据不同治疗方案分为两组,PFNA组(n=52)使用PFNA,Unite组(n=56)为在PFNA组基础上联合3DP定制钢板治疗。对比分析两组患者的一般资料、手术指标、Harris评分、炎症因子、术后并发症及满意度。采用随机行走模型评价两组患者手术指标、术后髋关节功能及炎症因子改善情况。结果 与PFNA组相比,Unite组骨折愈合时间更短及下床活动时间更短(P <0.05)。与PFNA组相比,Unite组术后12个月疼痛、功能、畸形、关节活动度及Harris总分均更高(P <0.05),术后1个月肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)及白细胞介素-1(IL-1)水平均更低(P <0.05)。随机行走模型评价结果显示,Unite组手术指标、术后髋关节功能及炎症因子的改善情况显著优于PFNA组。与PFNA组相比,Unite组术后12个月并发症发生率更低(P <0.05),满意度更高(P <0.05)。结论 对于治疗外侧壁粉碎的IFF患者,3DP定制钢板联合PFNA治疗,手术指标、术后髋关节功能及炎症因子的改善情况显著优于单用PFNA,且术后12个月并发症发生率更低、满意度更高。Objective To explore the application value of 3D⁃printing(3DP)customized steel plate combined with proximal femoral nail antirotation(PFNA)for intertrochanteric fracture of femur(IFF)with commi⁃nuted lateral wall.Methods A total of 108 patients with IFF with comminuted lateral wall who had been treated in our hospital from October 2018 to March 2021 were selected as research subjects.According to different treatment plans,they were divided into PFNA group(n=52)and Unite group(n=56).The general data,surgical indica⁃tors,Harris score,inflammatory factors,postoperative complications,and degree of satisfaction were compared and analyzed between the two groups.The random walk model was used to evaluate the improvement in surgical indicators,postoperative hip function and inflammatory factors in both groups.Results As compared with PFNA group,Unite group had shorter fracture healing and ambulation time(P<0.05).As compared with PFNA group,unite group had higher scores on pain,function,deformity,and joint range of motion and greater Harris total score 12 months after surgery(P<0.05),and lower levels of tumor necrosis factor⁃α(TNF⁃α),interleukin⁃6(IL⁃6)and interleukin⁃1(IL⁃1)one month after surgery(P<0.05).The evaluation results of random walk model showed that the improvement in surgical indexes,postoperative hip function and inflammatory factors was significantly better in Unite group than in PFNA group.As compared with PFNA group,Unite group had a lower incidence of 12⁃month postoperative complications(P<0.05)and higher degree of satisfaction(P<0.05).Conclusions For IFF patients with comminuted lateral wall,the improvement in surgical indicators,postoperative hip function and inflammatory factors was significantly better in Unite group than in PFNA group,and the incidence of 12⁃month postoperative complications was lower and the degree of satisfaction was higher.

关 键 词：3D打印 股骨近端防旋髓内钉 外侧壁 股骨 骨折 

分 类 号：R274.1[医药卫生—中医骨伤科学]