术前CT三维重建联合术中C型臂下不同入路内固定治疗髋部骨折的安全性及高危因素分析  

Analysis of safety and high risk factors of the internal fixations of different accesses in treating hip fractureunder C-shaped arm in combined surgery of preoperative CT and 3D reconstruction

作　　者：邹烽 谈军 陆威 严邦胜 Zou Feng;Tan Jun;Lu Wei;Yan Bangsheng(Department of Orthopaedics,The Second People's Hospital of Huishan District of Wuxi City,Wuxi 214000,China)

机构地区：[1]无锡市惠山区第二人民医院骨科,无锡214000

出　　处：《中国医学装备》2024年第10期69-73,共5页China Medical Equipment

基　　金：江苏省老年健康科研项目合同书(LSD2022009)。

摘　　要：目的:探讨术前CT三维重建联合术中C型臂下不同入路内固定治疗髋部骨折的安全性及高危因素。方法:选取2017年1月至2023年6月于无锡市惠山区第二人民医院就诊治疗的150例髋部骨折患者,术前均行CT三维重建,根据C型臂下手术入路和内固定方式不同,将其分为前入路组、后入路组、逆行入路组、直接入路组和混合入路组,每组30例。统计各组髋部骨折的并发症发生率,采用logistic回归分析影响手术安全性的高危因素以及各入路方式的优缺点。结果:前入路组、后入路组、逆行入路组、直接入路组和混合入路组患者髋部骨折的并发症发生率分别为36.67%、56.67%、80.00%、103.33%(其中1例患者同时出现2例并发症)和30.00%,各组并发症发病率比较差异有统计学意义(χ^(2)=11.35,P<0.05),且混合入路组<前入路组<后入路组<逆行入路组<直接入路组;不同年龄、骨折类型、手术技术、术前整体状况、麻醉风险、基础疾病、术前评估以及术后护理例数比较,差异均有统计学意义(F=26.520、30.652、41.500、25.389、46.370、59.170、24.150、45.355,P<0.05)。进一步logistic回归分析结果显示,高龄、严重骨折类型、手术技术、术前整体状况较差、麻醉风险高及存在基础疾病、未进行术前评估和术后护理均是影响手术安全性的高危因素(OR=1.388~2.479,P<0.05)。结论:术前行CT三维重建与术中C型臂辅助的不同入路内固定治疗髋部骨折相对安全,但并发症发生率因入路不同而异。前入路并发症发生率最高,混合入路最低。高龄、严重骨折、手术复杂性、术前状况差、麻醉风险、基础疾病、未评估和术后护理不足是手术安全的高风险因素,选择手术入路和内固定时,需考虑患者个体差异和手术风险,以提升成功率和安全性。Objective:To investigate the safety and risk factors of the internal fixations of different accesses in treating hip fracture under C-shaped arm in combined surgery of preoperative CT and 3D reconstruction.Methods:A total of 150 patients with hip fracture underwent preoperative computed tomography(CT)and three dimensional(3D)reconstruction in The Second People's Hospital of Huishan District of Wuxi City from January 2017 to June 2023 were selected,and they were divided into anterior access group,posterior access group,retrograde access group,direct access group and mixed access group according to different modes of surgery access and internal fixation under C-shaped arm,with 30 cases in each group.The incidence rate of complication of hip fracture in each group was calculated as statistical method,and logistic regression was used to analyze the high risk factors of affecting surgical safety,and the advantages and disadvantages of each access mode.Results:The incidence rates of the complication of hip fracture of patients of the anterior,posterior,retrograde,direct and mixed groups were respectively 36.67%,56.67%,80.00%,103.33%and 30.00%,and the difference of the incidence rates of complications among different groups was significantly(χ^(2)=11.35,P<0.05),and the incidence rates of them indicated that mixed access group<front access group<posterior access group<retrograde access group<direct access group.There were significant differences in ages,fracture type,surgical technique,preoperative overall status,anesthesia risk,basic disease,preoperative assessment and the number of the cases with postoperative care(F=26.520,30.652,41.500,25.389,46.370,59.170,24.150,45.355,P<0.05),respectively.The results of the further logistic regression analysis showed that advanced age,severe fracture type,surgical technique,poor overall preoperative condition,high risk of anesthesia and presence of basic disease,as well as without preoperative assessment and postoperative care were all high risk factors affecting surgical safety(O

关 键 词：术前CT 三维重建 C型臂 不同入路 髋部骨折 高危因素 

分 类 号：R816.8[医药卫生—放射医学]