榫卯结构导板联合偏轴固定治疗PauwelsⅢ型股骨颈骨折的疗效观察  

Effectiveness of guide plate with mortise-tenon joint structure combined with off-axis fixation in treatment of Pauwels typeⅢfemoral neck fractures

作　　者：朱烜烨 崔莉娟 张蕾蕾 贾宇东 朱英杰 刘又文 ZHU Xuanye;CUI Lijuan;ZHANG Leilei;JIA Yudong;ZHU Yingjie;LIU Youwen(Graduate School of Henan University of Traditional Chinese Medicine,Zhengzhou Henan,450046,P.R.China;College of Physical Education,Henan University,Kaifeng Henan,475000,P.R.China;Digital Orthopedic Center of Henan Luoyang Orthopaedic Hospital(Henan Orthopedic Hospital),Luoyang Henan,471000,P.R.China)

机构地区：[1]河南中医药大学研究生院,郑州450046 [2]河南大学体育学院,河南开封475000 [3]河南省洛阳正骨医院(河南省骨科医院)数字骨科中心,河南洛阳471000

出　　处：《中国修复重建外科杂志》2025年第3期284-289,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：洛阳市公益性项目行业医疗卫生专项(2022007A);河南省中医药科学研究专项课题(重大专项)(20-21ZYZD10)。

摘　　要：目的探讨3D打印榫卯结构导板引导下采用3枚空心加压螺钉结合1枚螺钉偏轴固定治疗PauwelsⅢ型股骨颈骨折的疗效。方法回顾性分析2022年8月—2023年8月收治且符合选择标准的78例PauwelsⅢ型股骨颈骨折患者临床资料,均采用3枚空心加压螺钉结合1枚螺钉偏轴固定治疗。术中26例采用榫卯结构导板辅助固定(榫卯结构导板组),28例采用传统导板(传统导板组),24例不使用导板(对照组)。3组患者性别、年龄、身体质量指数、致伤原因及骨折侧别等基线资料比较,差异均无统计学意义(P>0.05)。记录并比较3组手术时间、术中出血量、术中透视次数、手术切口长度、术后下肢深静脉血栓形成发生情况,术后1周疼痛视觉模拟评分(VAS)、术后3个月髋关节Harris评分;X线片复查骨折复位质量、骨折愈合,以及术后3个月股骨颈短缩长度、随访期间内固定失效及股骨头坏死发生情况。结果与对照组相比,两导板组手术时间、术中出血量、透视次数均减少,骨折复位质量更好,但手术切口更长,差异均有统计学意义(P<0.05)。传统导板组手术时间及术中出血量均高于榫卯结构导板组,手术切口亦更长,差异均有统计学意义(P<0.05);骨折复位质量及术中透视次数两组间差异无统计学意义(P>0.05)。传统导板组及对照组各1例下肢深静脉血栓形成,榫卯结构导板组无血栓形成;3组发生率差异无统计学意义(P>0.05)。3组患者均获随访,随访时间12~15个月,平均13个月。3组术后1周VAS评分、术后3个月Harris评分差异均无统计学意义(P>0.05)。影像学复查示,与对照组相比,两导板组骨折愈合时间短,术后3个月股骨颈短缩长度更短,差异均有统计学意义(P<0.05);上述指标两导板组间差异均无统计学意义(P>0.05)。随访期间3组骨折不愈合、股骨头坏死及内固定失效发生率差异均无统计学意义(P>0.05)。结论对于PauwelsⅢ型股骨�Objective To investigate the effectiveness of using 3 hollow compression screws combined with 1 screw off-axis fixation under the guidance of three-dimensional(3D)printed guide plate with mortise-tenon joint structure(mortise-tenon joint plate)for the treatment of Pauwels typeⅢfemoral neck fractures.Methods A clinical data of 78 patients with Pauwels typeⅢfemoral neck fractures,who were admitted between August 2022 and August 2023 and met the selection criteria,was retrospectively analyzed.The operations were assisted with mortise-tenon joint plates in 26 cases(mortise-tenon joint plate group)and traditional guide plates in 28 cases(traditional plate group),and without guide plates in 24 cases(control group).There was no significant difference in the baseline data of gender,age,body mass index,cause of injury,and fracture side between groups(P>0.05).The operation time,intraoperative blood loss,frequency of intraoperative fluoroscopy,incision length,incidence of postoperative deep vein thrombosis of lower extremity,pain visual analogue scale(VAS)score at 1 week after operation,and Harris score of hip joint at 3 months after operation were recorded and compared.X-ray re-examination was taken to check the quality of fracture reduction,fracture healing,and the shortening length of the femoral neck at 3 months after operation,and the incidences of internal fixation failure and osteonecrosis of the femoral head during operation.Results Compared with the control group,the operation time,intraoperative blood loss,and frequency of intraoperative fluoroscopy reduced in the two plate groups,and the quality of fracture reduction was better,but the incision was longer,and the differences were significant(P<0.05).The operation time and intraoperative blood loss were significantly higher in the traditional plate group than in the mortise-tenon joint plate group(P<0.05),the incision was significantly longer(P<0.05);and the difference in fracture reduction quality and the frequency of intraoperative fluoroscopy was not signif

关 键 词：榫卯结构导板 3D打印技术 股骨颈骨折 内固定 

分 类 号：R68[医药卫生—骨科学]