自主设计的预定位三维蜂窝导向器在经皮空心钉内固定治疗股骨颈骨折中的应用  

Application of a self-designed pre-positioned 3D honeycomb guide device in internal fixation with percutaneous cannulated screws for treatment of femoral neck fractures

作　　者：高峰[1] 徐锋[1] 尹自飞[1] 钱平康[1] 匡辰 杨荃 吴晓峰[1] Gao Feng;Xu Feng;Yin Zifei;Qian Pingkang;Kuang Chen;Yang Quan;Wu Xiaofeng(Department of Orthopaedics,Kunshan Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Traditional Chinese Medicine,Kunshan 215300,China)

机构地区：[1]南京中医药大学附属昆山市中医医院骨科,昆山215300

出　　处：《中华创伤骨科杂志》2024年第2期111-117,共7页Chinese Journal of Orthopaedic Trauma

基　　金：苏州市临床重点病种诊疗技术专项项目(LCZX202127)。

摘　　要：目的探讨采用自主设计的预定位三维蜂窝导向器辅助经皮空心钉内固定治疗股骨颈骨折的疗效。方法回顾性分析2019年6月至2022年6月南京中医药大学附属昆山市中医医院骨科采用空心钉内固定治疗的60例股骨颈骨折患者资料。根据术中定位方式不同分为2组:研究组(采用自主设计的预定位三维蜂窝导向器辅助置入空心钉固定)30例和对照组(采用徒手操作置入空心钉固定)30例。研究组男17例,女13例;年龄(44.9±9.2)岁;Garden分型:Ⅱ型2例,Ⅲ型18例,Ⅳ型10例。对照组男11例,女19例;年龄(43.5±7.9)岁;Garden分型:Ⅱ型1例,Ⅲ型16例,Ⅳ型13例。所有骨折均行闭合复位3枚空心钉倒三角内固定。比较两组患者Garden对线指数、手术时间、透视次数、导针钻孔次数、骨折愈合时间及末次随访时髋关节Harris评分;测量两组患者术后影像学指标,包括螺钉间距、螺钉至颈皮质距离、螺钉覆盖面积、螺钉间平行偏差、螺钉与颈轴线偏差。结果两组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。所有患者术后获(14.4±1.9)个月随访。研究组患者的手术时间[(33.1±5.5)min]、透视次数[(13.7±2.2)次]、导针钻孔次数[(3.7±0.6)次]、螺钉至颈皮质距离[(12.4±2.8)mm]、正位X线片上螺钉间平行偏差(2.2°±1.1°)、侧位X线片上螺钉间平行偏差(2.4°±1.0°)、正位X线片上螺钉与颈轴线偏差(4.0°±0.9°)、侧位X线片上螺钉与颈轴线偏差(3.2°±0.8°)均优于对照组[(46.5±8.6)min、(23.1±5.2)次、(11.0±2.2)次、(19.0±3.3)mm、6.5°±2.6°、7.1°±2.9°、7.7°±2.6°、9.2°±3.1°],差异均有统计学意义(P<0.05)。研究组患者的螺钉间距[(45.7±5.8)mm]、螺钉覆盖面积[(74.1±10.9)mm^(2)]均大于对照组[(31.3±7.7)mm、(55.5±9.0)mm^(2)],差异均有统计学意义(P<0.05)。两组患者Garden对线指数、骨折愈合时间、随访时间、末次随访时髋关节Harris评分比�Objective To evaluate our self-designed pre-positioned 3D honeycomb guide device in the internal fixation with percutaneous cannulated screws for femoral neck fractures.Methods A retrospective study was conducted to analyze the data of 60 patients with femoral neck fracture who had been treated with cannulated screw fixation at Department of Orthopaedics,Kunshan Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Traditional Chinese Medicine from June 2019 to June 2022.According to the difference in intraoperative positioning for placement of cannulated screws,the patients were divided into a study group of 30 cases whose placement of cannulated screws was assisted by our self-designed pre-positioned 3D honeycomb guide device,and a control group of 30 cases whose cannulated screws were positioned freehand.In the study group,there were 17 males and 13 females with an age of(44.9±9.2)years,and 2 cases of type Ⅱ,18 cases of type Ⅲ,and 10 cases of type Ⅳ by the Garden classification.In the control group,there were 11 males and 19 females with an age of(43.5±7.9)years,and 1 case of type Ⅱ,16 cases of type Ⅲ,and 13 cases of type Ⅳ by the Garden classification.Closed reduction and inverted triangle internal fixation with 3 cannulated screws were conducted for all fractures.The Garden crossline index,operation time,fluoroscopy frequency,needle drillings,fracture healing time,and Harris hip functional score at the last follow-up were compared between the 2 groups.The postoperative imaging indicators in the 2 groups were measured,including screw spacing,distance from screw to neck cortex,screw coverage area,parallel deviation between screws,and deviation from screw to neck axis.Results There were no statistically significant differences in the baseline characteristics between the 2 groups,indicating comparability(P>0.05).All patients were followed up for(14.4±1.9)months after surgery.In the study group,operation time[(33.1±5.5)min],fluoroscopy frequency[(13.7±2.2)times],needle dril

关 键 词：股骨颈骨折 骨折固定术 内 骨钉 导向器 

分 类 号：R687.3[医药卫生—骨科学]