3D打印经皮手术导板在股骨颈骨折闭合复位空心螺钉内固定术中的应用  

Application of 3D printing percutaneous guide plate in closed reduction and cannulated screw internal fixation of femoral neck fracture

作　　者：王清泽 罗明星 曾帅 鲍军国 罗文礼 袁凯宗 劳立峰 WANG Qing-ze;LUO Ming-xing;ZENG Shuai;BAO Jun-guo;LUO Wen-li;YUAN Kai-zong;LAO Li-feng(Department of Orthopaedics,Ningbo Hangzhou Bay Hospital,Ningbo315000,Zhejiang,China)

机构地区：[1]宁波市杭州湾医院骨科,浙江宁波315000

出　　处：《中国骨伤》2023年第3期209-215,共7页China Journal of Orthopaedics and Traumatology

基　　金：宁波市医学科技计划项目(编号:2019Y27)。

摘　　要：目的:探讨3D打印经皮手术导板在股骨颈骨折闭合复位空心螺钉内固定术中的应用效果。方法:回顾分析2019年3月至2022年3月收治的12例股骨颈骨折患者临床资料。根据手术方案不同将患者分为观察组和对照组,各6例。观察组行经皮手术导板辅助闭合复位空心螺钉内固定术,对照组行闭合复位空心加压螺钉内固定术。比较两组患者手术操作时间、术中出血量、透视次数、克氏针穿刺次数,术后复查X线片记录螺钉位置分布、随访时间、骨折完全愈合时间、术后1年髋关节Harris评分及并发症发生情况。结果:观察组手术操作时间(32.17±6.18)min短于对照组(53.83±7.31)min(P<0.05);观察组术中出血量(18.33±2.94)ml小于对照组(38.17±5.56)ml(P<0.05);观察组透视次数(7.50±1.05)次少于对照组(21.00±4.82)次(P<0.05);观察组克氏针穿刺次数(8.00±0.63)次少于对照组(32.67±3.08)次(P<0.05)。观察组随访时间(12.88±0.74)个月,对照组(12.83±0.72)个月,两组差异无统计学意义(P>0.05)。观察组术后1年髋关节Harris评分(82.00±4.52)分,对照组(81.00±3.41)分,两组差异无统计学意义(P>0.05)。观察组骨折完全愈合时间(7.50±1.05)个月,对照组(7.67±1.21)个月,两组差异无统计学意义(P>0.05)。观察组螺钉相互平行度正位(0.50±0.11)°、侧位(0.76±0.15)°,均低于对照组正位(1.57±0.31)°、侧位(1.87±0.21)°(P<0.05)。观察组螺钉分布面积比(0.13±0.02)cm2高于对照组(0.08±0.01)cm2(P<0.05)。两组术后均无股骨头坏死、骨折不愈合、股骨颈短缩、内固定物退钉等并发症发生。结论:应用3D打印经皮手术导板提高了股骨颈骨折闭合复位空心螺钉内固定术的准确性及安全性,具有微创、减少射线暴露、快速、精准等优势,缩短了手术时间,减少了术中出血量。Objective To investigate the application of 3D printing percutaneous surgical guide plate in closed reduction and cannulated screw internal fixation of femoral neck fracture.Methods The clinical data of 12 patients with femoral neck fracture from March 2019 to March 2022 were retrospectively analyzed.Patients were divided into observation group and control group according to different operation plans,with 6 cases in each group.The observation group received percutaneous operation guide plate assisted closed reduction and hollow screw internal fixation,while the control group received closed reduction and hollow compression screw internal fixation.The operation time,intraoperative blood loss,fluoroscopy times,and Kirschner needle puncture times were compared between two groups.The location of screws were recordedon postoperative X-ray films,follow-up time,time of complete fracture healing,Harris score of hip joint and the incidence of complications were recorded on postoperative X-ray films.Results The operation time of observation group(32.17±6.18)min was shorter than that of control group(53.83±7.31)min(P<0.05).The amount of intraoperative bleeding in the observation group(18.33±2.94)ml was less than that in the control group(38.17±5.56)ml(P<0.05).The times of fluoroscopy in the observation group(7.50±1.05)were less than those in the control group(21.00±4.82)(P<0.05).The number of Kirschner needle punctures(8.00±0.63)in observation group was less than that in control group(32.67±3.08)(P<0.05).The follow-up time was(12.88±0.74)months in observation group and(12.83±0.72)months in control group,there was no significant difference between two groups(P>0.05).One year after operation,Harris score of hip joint in the observation group was(82.00±4.52)points,while that in the control group was(81.00±3.41)points,there was no significant difference between two groups(P>0.05).The time of complete fracture healing in the observation group was(7.50±1.05)months,while that in the control group was(7.67±1.21)months

关 键 词：股骨颈骨折 闭合复位 空心螺钉 内固定 3D打印 经皮手术导板 

分 类 号：R687.3[医药卫生—骨科学]