目的 探讨数字定位结合3D打印技术，在股骨颈骨折空心螺钉内固定治疗中经皮穿刺导航模板的应用价值和临床效果研究。 方法 选取2022年至2023年间我院接受股骨颈骨折内固定手术的患者36例，随机分为3D组和传统组，每组各18例。传统组采用传统徒手置钉，3D组应用数字定位结合3D打印导板进行内固定手术。比较两组手术时间、术中出血量、克氏针穿刺次数、术中X线曝光次数、影像指标和随访结果。 结果 3D组的术中出血量、平均手术操作时间、术中X线曝光次数和克氏针穿刺次数均低于传统组（P<0.001），影像学评价显示，3D组螺钉间距、螺钉与股骨颈轴线夹角平均低于传统组，3D组螺钉分布面积比与螺钉至颈皮质距离高于传统组，差异均有统计学意义(P<0.05) 。两组患者术后随访住院时间、完全负重活动时间、骨折完全愈合时间及并发症发生情况，末次随访未见股骨头坏死病例，差异均无统计学意义( P>0.05)，随访术后1、3、6个月及末次随访Harris评分差异均无统计学意义(P>0.05)。 结论 数字定位技术结合3D打印经皮穿刺导板在股骨颈骨折内固定治疗中，可以显著提高手术精度和复位质量，减少手术时间、术中出血量、透视次数和克氏针穿刺次数。
Abstract
Objective To study the application value and clinical effect of digital positioning combined with 3D printed technology in the treatment of femoral neck fracture with screw internal fixation. Methods Thirty-six patients undergoing internal fixation for femoral neck fracture in our hospital between 2022 and 2023 were randomly divided into a 3D group and a traditional group, with 18 patients in each group. The traditional group used traditional freehand nailing, and the 3D group applied digital positioning combined with 3D printed guide plate for internal fixation surgery. Operation time, intraoperative blood loss, times of K-wire puncture, intraoperative X-ray exposure times, imaging index, and follow-up results were compared between the two groups. Results The intraoperative blood loss, mean surgical operation time, intraoperative X-ray exposure times and times of K-wire puncture in 3D group were lower than those of the traditional group (P<0.001). The imaging evaluation result showed that the screw spacing, angle between screw and femoral neck axis in the 3D group were lower than those of the traditional group. The ratio of screw distribution area and the distance from screw to cervical cortex in in the 3D group was higher than those of the traditional group, and the difference was statistically significant (P<0.05). There were no statistical differences in the length of hospitalization, time of complete weight-bearing activity, complete healing of the fracture, and occurrence of complications, no cases of femoral head necrosis at the last follow-up between the two groups (P>0.05). There were no statistical differences in Harris scores at 1, 3, and 6 months and the last follow-up (P>0.05). Conclusions Digital positioning technology combined with 3D printed percutaneous puncture guide plate in the treatment of femoral neck fracture internal fixation, can significantly improve the surgical accuracy and reduction quality, and reduce the operation time, intraoperative blood loss, fluoroscopy times and number of Kirschner needle puncture.
关键词
股骨颈骨折； /
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3D打印； /
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数字定位； /
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经皮穿刺导板； /
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内固定
Key words
Femoral neck fracture; /
3D printing; /
Digital positioning; /
Percutaneous puncture guide plate; /
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Internal fixation
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基金
湖南省教育厅科学研究重点项目（24A0766）；湖南省自然科学基金（2022JJ50292）；湖南医药学院教学改革项目（2021JG39）；怀化市数字解剖与3D打印临床转化研究重点实验室项目（2020R01）；横向课题：开放+桥基式3D导板在脑出血穿刺中的研究（2023hx02）；数字化三定式导向器在椎间孔镜手术中的应用研究（2023hx03）；湖南医药学院科研孵化库建设项目
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