目的 探讨数字化3D模型虚拟手术对闭合复位顺行带锁髓内钉固定术治疗股骨干骨折的指导意义，评估其对治疗效果的影响。 方法 选取本院2013年1月至2016年12月，闭合复位顺行带锁髓内钉固定术治疗的股骨干骨折病例80例，随机分为2组。研究组术前进行CT图像三维数字化重建并模拟手术过程，用以指导实际手术操作；对照组按照常规检查制定手术方案。比较两组手术时间、X线照射时间、术中出血量及术后随访情况。 结果 研究组的手术时间、X线照射时间与对照组相比均有统计学差异，术中出血量无统计学差异。患者术后切口均Ⅰ期愈合，无感染等并发症。随访16~38个月，患者完全痊愈后均未发生疼痛，步态正常，均恢复日常生活及髋关节正常活动。X线片复查示骨折愈合良好。 结论 股骨干骨折髓内钉固定术前进行3D重建及虚拟手术可指导手术过程，提高手术效率，具有较好的临床应用价值。
Abstract
Objective To investigate the effects of closed reduction anterograde locking intramedullary nailing in the treatment of femoral shaft fractures with digital 3D model virtual surgical scheme. Methods From January 2013 to December 2016, 80 cases of femoral shaft fractures were treated with closed reduction and anterograde interlocking intramedullary nail. They were randomly divided into two groups: a treatment group and a control group. The treatment group underwent three-dimensional digital reconstruction of CT images, simulated the operation process, determined the selection of instruments and the location of nailing, and operated according to the virtual simulation scheme. The control group was given routine examination and surgical treatment. The operation time, X-ray time, intraoperative bleeding volume and prognosis were observed and followed up. Results There were statistical difference in the operation time and X-ray irradiation time of the treatment group from those in the control group, but there was no significant difference in the amount of bleeding during the operation. All the incisions healed in the first stage without any complications such as infection. The follow-up period ranged from 16 to 38 months. All patients recovered completely without pain and abnormal gait, and resumed normal daily life and hip joint activities. Conclusions Preoperative 3D reconstruction and virtual surgery for femoral shaft fracture with intramedullary nailing can significantly guide the surgical process, it is valuable for clinic application.
关键词
股骨干骨折 /
髓内钉 /
虚拟手术 /
三维数字化模型
Key words
Fracture of femoral shaft /
Intramedullary nail /
Virtual surgery /
Three-dimensional digital model
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基金
南宁市科学研究与技术开发计划项目（20133176），广东省医学科研基金（A2019334）
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