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[1]宛磊,張世魁,吳大龍,等.CT三維重建和手術(shù)模擬輔助股骨近端防旋髓內(nèi)釘內(nèi)固定治療老年股骨轉(zhuǎn)子間骨折的臨床研究[J].中醫(yī)正骨,2022,34(02):7-11.
　WAN Lei,ZHANG Shikui,WU Dalong,et al.Proximal femoral nail antirotation internal fixation assisted by three-dimensional CT reconstruction and surgery simulation for treatment of intertrochanteric fractures in the aged:a clinical study[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2022,34(02):7-11.
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CT三維重建和手術(shù)模擬輔助股骨近端防旋髓內(nèi)釘內(nèi)固定治療老年股骨轉(zhuǎn)子間骨折的臨床研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第34卷
期數(shù):
2022年02期
頁(yè)碼:
7-11
欄目:
臨床研究
出版日期:
2022-02-20

文章信息/Info

Title:
Proximal femoral nail antirotation internal fixation assisted by three-dimensional CT reconstruction and surgery simulation for treatment of intertrochanteric fractures in the aged:a clinical study
作者:
宛磊; 張世魁; 吳大龍; 岳龍; 于蒙洋; 單文亞; 李智浩; 張紹安
漯河醫(yī)學(xué)高等專科學(xué)校第二附屬醫(yī)院,河南 漯河 462300
Author(s):
WAN Lei; ZHANG Shikui; WU Dalong; YUE Long; YU Mengyang; SHAN Wenya; LI Zhihao; ZHANG Shaoan
The Second Affiliated Hospital of Luohe Medical College,Luohe 462300,Henan,China
關(guān)鍵詞:
髖骨折;  股骨;  轉(zhuǎn)子間骨折;  老年人;  成像; 三維;  手術(shù)模擬;  股骨近端防旋髓內(nèi)釘;  骨折固定術(shù); 內(nèi);  臨床試驗(yàn)
Keywords:
hip fractures;  femur;  intertrochanteric fractures;  aged;  imaging; three-dimensional;  surgery simulation;  proximal femoral nail antirotation;  fracture fixation; internal;  clinical trial
摘要:
目的:探討CT三維重建和手術(shù)模擬輔助股骨近端防旋髓內(nèi)釘(proximal femoral nail antirotation,PFNA)內(nèi)固定治療老年股骨轉(zhuǎn)子間骨折的臨床療效和安全性。方法:納入117例老年股骨轉(zhuǎn)子間骨折患者,隨機(jī)分為輔助治療組和常規(guī)治療組。輔助治療組在術(shù)前常規(guī)CT檢查后,將CT掃描原始數(shù)據(jù)導(dǎo)入Mimics醫(yī)學(xué)影像處理軟件進(jìn)行三維重建,并模擬PFNA內(nèi)固定手術(shù); 常規(guī)治療組在術(shù)前常規(guī)CT檢查后,不進(jìn)行三維重建和手術(shù)模擬。2組患者均采用PFNA內(nèi)固定治療。比較2組患者的一次置釘成功率、手術(shù)時(shí)間、術(shù)中出血量、住院時(shí)間、Harris髖關(guān)節(jié)評(píng)分及并發(fā)癥發(fā)生率。結(jié)果:①一般結(jié)果。輔助治療組58例,術(shù)中一次置釘成功47例; 常規(guī)治療組59例,術(shù)中一次置釘成功33例; 輔助治療組患者一次置釘成功率高于常規(guī)治療組(χ2=8.523,P=0.004); 輔助治療組患者手術(shù)時(shí)間短于常規(guī)治療組[(86.3±10.7)min,(121.5±11.6)min,t=17.053,P=0.000],術(shù)中出血量少于常規(guī)治療組[(247.8±22.5)mL,(286.9±17.8)mL,t=10.434,P=0.000]; 2組患者住院時(shí)間比較,差異無(wú)統(tǒng)計(jì)學(xué)意義[(10.3±2.6)d,(10.7±2.2)d,t=0.899,P=0.371]。②Harris髖關(guān)節(jié)評(píng)分。時(shí)間因素和分組因素不存在交互效應(yīng)(F=0.161,P=0.527); 2組患者Harris髖關(guān)節(jié)評(píng)分比較,組間差異無(wú)統(tǒng)計(jì)學(xué)意義,即不存在分組效應(yīng)(F=1.031,P=0.375); 手術(shù)前后不同時(shí)間點(diǎn)Harris髖關(guān)節(jié)評(píng)分的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=38.754,P=0.000); 術(shù)前、術(shù)后6個(gè)月、術(shù)后12個(gè)月,2組患者Harris髖關(guān)節(jié)評(píng)分均呈上升趨勢(shì),且2組的上升趨勢(shì)完全一致[(38.7±5.6)分,(88.7±6.4)分,(92.5±6.2)分,F=21.781,P=0.000;(29.2±6.7)分,(85.3±5.9)分,(90.7±7.8)分,F=43.658,P=0.000]。③并發(fā)癥發(fā)生率。輔助治療組患者均未發(fā)生術(shù)中螺釘穿出、髖內(nèi)翻畸形、下肢短縮等并發(fā)癥,常規(guī)治療組1例患者發(fā)生下肢短縮。2組患者并發(fā)癥發(fā)生率比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(χ2=0.992,P=0.319)。結(jié)論:CT三維重建和手術(shù)模擬輔助PFNA內(nèi)固定治療老年股骨轉(zhuǎn)子間骨折與PFNA內(nèi)固定比較,臨床療效和安全性相當(dāng),但前者的一次置釘成功率高、手術(shù)時(shí)間短、術(shù)中出血少。
Abstract:
Objective:To explore the clinical curative effects and safety of proximal femoral nail antirotation(PFNA)internal fixation assisted by three-dimensional(3D)CT reconstruction and surgery simulation for treatment of intertrochanteric fractures in the aged.Methods:One hundred and seventeen aged patients with intertrochanteric fractures were enrolled in the study and were randomly divided into adjuvant treatment group(58 cases)and conventional treatment group(59 cases).The patients in adjuvant treatment group received preoperative CT examination,and their CT data were transmitted to the medical image processing software(Mimics)for 3D reconstruction,and the PFNA internal fixation surgery was simulated; while the ones in conventional treatment group only received preoperative CT examination.All patients in the 2 groups were treated with PFNA internal fixation.The success rate of one-time nail placement,operative time,intraoperative blood loss,hospital stay,Harris hip score and complication incidence rate were compared between the 2 groups.Results:①The successful intraoperative one-time nail placement was found in 47 patients in adjuvant treatment group and 33 ones in conventional treatment group.The success rate of one-time nail placement was higher in adjuvant treatment group compared to conventional treatment group(χ2=8.523,P=0.004).The operative time was shorter and the intraoperative blood loss was less in adjuvant treatment group compared to conventional treatment group(86.3±10.7 vs 121.5±11.6 minutes,t=17.053,P=0.000; 247.8±22.5 vs 286.9±17.8 mL,t=10.434,P=0.000).There was no statistical difference in hospital stay between the 2 groups(10.3±2.6 vs 10.7±2.2 days,t=0.899,P=0.371).②There was no interaction between time factor and group factor in Harris hip score(F=0.161,P=0.527).There was no statistical difference in Harris hip score between the 2 groups,in other words,there was no group effect(F=1.031,P=0.375).There was statistical difference in Harris hip score between different timepoints before and after the surgery,in other words,there was time effect(F=38.754,P=0.000).The Harris hip scores presented a time-dependent increasing trend in the 2 groups before the surgery,on month 6 and month 12 after the surgery,and the 2 groups were completely consistent with each other in the variation tendency(38.7±5.6,88.7±6.4,92.5±6.2 points,F=21.781,P=0.000; 29.2±6.7,85.3±5.9,90.7±7.8 points,F=43.658,P=0.000).③No complications such as intraoperative nail penetration,coxa vara deformity and lower limb shortening were found in adjuvant treatment group,while the lower limb shortening was found in 1 patient in conventional treatment group.There was no statistical difference in complication incidence rate between the 2 groups(χ2=0.992,P=0.319).Conclusion:PFNA internal fixation assisted by 3D CT reconstruction and surgery simulation is similar to conventional PFNA internal fixation in clinical curative effects and safety in treatment of intertrochanteric fractures in the aged,while the former displays the advantages of higher success rate of one-time nail placement,shorter operative time and less intraoperative blood loss compared to the latter.

參考文獻(xiàn)/References:

[1] 張紅英,王芳平.針對(duì)性護(hù)理對(duì)老年股骨轉(zhuǎn)子間骨折患者髖關(guān)節(jié)置換術(shù)療效的影響[J].海軍醫(yī)學(xué)雜志,2017,38(1):77-79.
[2] GUY P,SOBOLEV B,SHEEHAN K J,et al.The burden of second hip fractures:provincial surgical hospitalizations over 15 years[J].Can J Surg,2017,60(2):101-107.
[3] RAGHURAMAN R,KAM J W,CHUA D T C.Predictors of failure following fixation of intertrochanteric fractures with proximal femoral nail antirotation[J].Singapore Med J,2019,60(9):463-467.
[4] 王正安,游鎮(zhèn)君,蔣毅.快速康復(fù)外科理念在老年股骨轉(zhuǎn)子間骨折圍手術(shù)期治療中的應(yīng)用[J].中醫(yī)正骨,2019,31(11):17-20.
[5] MA L,ZHOU Y,ZHU Y,et al.3D printed personalized titanium plates improve clinical outcome in microwave ablation of bone tumors around the knee[J].Sci Rep,2017,7(1):7626.
[6] ZHANG W,ANTONY XAVIER R P,DECRUZ J,et al.Risk factors for mechanical failure of intertrochanteric fractures after fixation with proximal femoral nail antirotation(PFNA II):a study in a Southeast Asian population[J].Arch Orthop Trauma Surg,2021,141(4):569-575.
[7] FUTAMURA K,BABA T,HOMMA Y,et al.New classification focusing on the relationship between the attachment of the iliofemoral ligament and the course of the fracture line for intertrochanteric fractures[J].Injury,2016,47(8):1685-1691.
[8] 強(qiáng)敏菲,陳雁西,張坤,等.計(jì)算機(jī)輔助術(shù)前計(jì)劃在老年股骨轉(zhuǎn)子間骨折治療中的應(yīng)用價(jià)值[J].中華骨科雜志,2017,37(17):1061-1068.
[9] 中華中醫(yī)藥學(xué)會(huì).中醫(yī)骨傷科常見(jiàn)病診療指南[M].北京:中國(guó)中醫(yī)藥出版社,2012:154-157.
[10] 蔣協(xié)遠(yuǎn),王大偉.骨科臨床療效評(píng)價(jià)標(biāo)準(zhǔn)[M].北京:人民衛(wèi)生出版社,2005:132-134.
[11] 劉志雄.骨科常用診斷分類方法和功能結(jié)果評(píng)定標(biāo)準(zhǔn)[M].北京:北京科學(xué)技術(shù)出版社,2005:268-270.
[12] AVENELL A,SMITH T O,CURTAIN J P,et al.Nutritional supplementation for hip fracture aftercare in older peo-ple[J/OL].Cochrane Database Syst Rev,2016,11(11)[2021-05-22].https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6464805/.
[13] ORWIG D,HOCHBERG M C,GRUBER-BALDINI A L,et al.Examining differences in recovery outcomes between male and female hip fracture patients:design and baseline results of a prospective cohort study from the baltimore hip studies[J].J Frailty Aging,2018,7(3):162-169.
[14] BORGES F K,BHANDARI M,PATEL A,et al.Rationale and design of the hip fracture accelerated surgical treatment and care track(HIP ATTACK)trial:a protocol for an international randomised controlled trial evaluating early surgery for hip fracture patients[J/OL].BMJ Open,2019,9(4)[2021-05-22].https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6501985/.
[15] BOUDISSA M,COURVOISIER A,CHABANAS M,et al.Computer assisted surgery in preoperative planning of acetabular fracture surgery:state of the art[J].Expert Rev Med Devices,2018,15(1):81-89.
[16] LELAND N E,LEPORE M,WONG C,et al.Delivering high quality hip fracture rehabilitation:the perspective of occupational and physical therapy practitioners[J].Disabil Rehabil,2018,40(6):646-654.
[17] 楊晶.計(jì)算機(jī)輔助設(shè)計(jì)3D打印技術(shù)在復(fù)雜跟骨骨折治療中的應(yīng)用[J].國(guó)際骨科學(xué)雜志,2017,38(1):51-54.
[18] CHEPELEV L,WAKE N,RYAN J,et al.Radiological Society of North America(RSNA)3D printing Special Interest Group(SIG):guidelines for medical 3D printing and appropriateness for clinical scenarios[J].3D Print Med,2018,4(1):11.
[19] NHERERA L,TRUEMAN P,HORNER A,et al.Comparison of a twin interlocking derotation and compression screw cephalomedullary nail(InterTAN)with a single screw derotation cephalomedullary nail(proximal femoral nail antirotation):a systematic review and meta-analysis for intertrochanteric fractures[J].J Orthop Surg Res,2018,13(1):46.
[20] KAMMERLANDER C,HEM E S,KLOPFER T,et al.Cement augmentation of the proximal femoral nail antirotation(PFNA)-a multicentre randomized controlled trial[J].Injury,2018,49(8):1436-1444.
[21] 江孝龍,蔣國(guó)華,孫賢杰.股骨近端防旋髓內(nèi)釘內(nèi)固定與動(dòng)力髖螺釘內(nèi)固定治療老年股骨轉(zhuǎn)子間骨折的對(duì)比研究[J].中醫(yī)正骨,2019,31(2):8-13.
[22] 王鄭浩,李開(kāi)南.基于CT三維重建技術(shù)繪制骨折地圖的臨床應(yīng)用進(jìn)展[J].中華創(chuàng)傷骨科雜志,2020,22(2):175-179.
[23] 吳發(fā)財(cái),楊東輝,陳琦,等.CT三維重建在股骨轉(zhuǎn)子間骨折分型中的應(yīng)用[J].中國(guó)CT和MRI雜志,2018,16(11):140-143.
[24] 吳曉東,獨(dú)行業(yè),周正明.計(jì)算機(jī)輔助設(shè)計(jì)數(shù)字化鋼板固定治療髖臼后壁骨折伴髖關(guān)節(jié)脫位[J].中華創(chuàng)傷骨科雜志,2018,20(5):439-442.
[25] 夏鐵男,商冠寧.3D打印技術(shù)在骨科應(yīng)用現(xiàn)狀的研究進(jìn)展[J].中華實(shí)用診斷與治療雜志,2020,34(7):742-744.

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備注/Memo:
基金項(xiàng)目:河南省醫(yī)學(xué)科技攻關(guān)計(jì)劃項(xiàng)目(LHGJ20200880)
更新日期/Last Update: 2022-02-20