基于虚拟设计髓内钉钢板固定A2-3型股骨粗隆间骨折  

Proximal femoral nail anti-rotation combined buttress plate based on preoperative visual design for type A2-3 femoral intertrochanteric fracture

作　　者：杨绍武 桂炜炜 李影 YANG Shao-wu;GUI Wei-wei;LI Ying(Department of Traumatic Orthopedics,Jiujiang Hospital of Traditional Chinese Medicine,Jiujiang,Jiangxi 332000,China)

机构地区：[1]九江市中医院骨伤科,江西九江332000

出　　处：《中国矫形外科杂志》2025年第3期200-206,共7页Orthopedic Journal of China

基　　金：江西省卫生厅科技计划课题项目(编号:20143268)。

摘　　要：[目的]探讨Mimics辅助虚拟设计股骨近端髓钉内联合锁定钢板固定A2-3型股骨粗隆间骨折的临床疗效。[方法]回顾性分析2018年1月—2021年6月本院创伤骨科采用开放复位内固定(open reduction and internal fixation,ORIF)治疗的53例A2-3型股骨粗隆间骨折患者的临床资料。根据医患沟通结果,28例依据术前Mimics软件辅助设计行ORIF(设计组),25例未选择辅助设计,行常规ORIF(常规组)。比较两组围手术期、随访及影像结果。[结果]设计组手术时间[(52.7±5.2)min vs(69.5±7.1)min,P<0.001]、术中出血量[(102.7±10.9)ml vs(165.9±10.7)ml,P<0.001]、术中透视次数[(8.3±2.1)次vs(10.2±3.5)次,P=0.018]均显著优于常规组。设计组完全负重时间[(36.3±5.8)d vs(47.5±6.3)d,P<0.001]显著早于常规组。术后随时间推移,两组Harris评分、髋伸屈ROM、髋内外旋ROM均显著增加(P<0.05),术后1、6个月,设计组髋关节上述临床指标均显著优于常规组(P<0.05)。影像方面,两组患者骨折复位质量优良率的差异无统计学意义(P>0.05)。至末次随访时,设计组的颈干角(neck-shaft angle,NSA)无变化,而常规组NSA显著减小(P<0.05)。末次随访时,设计组在尖-顶距(tip-apex distance,TAD)及股骨头颈短缩值均显著优于常规组(P<0.05)。[结论]对累及外侧壁的股骨粗隆间骨折,术前虚拟辅助设计能够为术者提供精准的分型和个体化的固定方案,缩短手术时间,减少内固定失效的发生率。[Objective]To evaluate the clinical significance of preoperative Mimics-assisted design of proximal femoral nail anti-rotation(PFNA)combined with buttress plate fixation of type A2-3 femoral intertrochanteric fractures.[Methods]A retrospective analysis was performed on 53 patients who received open reduction and internal fixation(ORIF)with PFNA and buttress plate for type A2-3 femoral intertrochanteric fractures in our hospital from January 2018 to June 2021.According to the preoperative doctor-patient communication,28 patients had ORIF performed based on preoperative design with Mimics software,while other 25 patients had routine ORIF conducted without preoperative digital design(routine group).The documents regarding to perioperative period,follow-up and images were compared between the two groups.[Results]The design group proved significantly superior to the routine groups in terms of operation time[(52.7±5.2)min vs(69.5±7.1)min,P<0.001],intraoperative blood loss[(102.7±10.9)ml vs(165.9±10.7)ml,P<0.001],intraoperative fluoroscopy times[(8.3±2.1)times vs(10.2±3.5)times,P=0.018].In addition,the design group resumed full loading activity significantly earlier than that of the routine group[(36.3±5.8)days vs(47.5±6.3)days,P<0.001].The Harris score,hip extension-flexion ROM and internal-external rotation ROM significantly increased in both groups over time(P<0.05),which were significantly better in the design group than the routine group at 1 month and 6 months after surgery.With respect of imaging,there was no statistically significant difference in the fracture reduction quality between the two groups(P>0.05).The design group had the neck-shaft angle(NSA)remained unchanged,whereas the routine group had NSA significantly decreased by the latest follow-up(P<0.05).At corresponding time points after surgery,the design group proved significantly better than the routine group in tip-apex distance(TAD)and femoral head and neck shortening(P<0.05).[Conclusion]For femoral intertrochanteric fractures involving the l

关 键 词：股骨粗隆间骨折 外侧壁 虚拟设计 股骨近端防旋髓内钉 支撑钢板 

分 类 号：R683.42[医药卫生—骨科学]