[1]王定,袁见华,王大勇,等.髋外侧分区法植入前置针在股骨颈骨折经皮空心螺钉内固定术中的应用[J].中医正骨,2024,36(03):31-35.
 WANG Ding,YUAN Jianhua,WANG Dayong,et al.Application of pre-inserting a needle via lateral hip zoning method in the surgery of percutaneous hollow screw internal fixation for treatment of femoral neck fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2024,36(03):31-35.
点击复制

髋外侧分区法植入前置针在股骨颈骨折经皮空心螺钉内固定术中的应用()
分享到:

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第36卷
期数:
2024年03期
页码:
31-35
栏目:
临床研究
出版日期:
2024-03-20

文章信息/Info

Title:
Application of pre-inserting a needle via lateral hip zoning method in the surgery of percutaneous hollow screw internal fixation for treatment of femoral neck fractures
作者:
王定袁见华王大勇曹锦
杭州市临平区第一人民医院,浙江 杭州 311100
Author(s):
WANG DingYUAN JianhuaWANG DayongCAO Jin
The First People's Hospital of Linping District,Hangzhou 311100,Zhejiang,China
关键词:
股骨颈骨折 骨折固定术 骨螺丝 临床试验
Keywords:
femoral neck fractures fracture fixationinternal bone screws clinical trial
摘要:
目的:探讨髋外侧分区法植入前置针在股骨颈骨折经皮空心螺钉内固定术中的应用价值。方法:回顾性分析2018年3月至2022年3月收治的60例采用经皮空心螺钉内固定术治疗的股骨颈骨折患者的病例资料,其中采用髋外侧分区法植入前置针辅助植入空心螺钉者纳入髋外侧分区组,依据经验植入空心螺钉者纳入传统组。比较2组患者的术中X线透视次数、手术时间、术中钻孔次数、骨折愈合时间和末次随访时的Harris髋关节评分。结果:髋外侧分区组和传统组各有1例患者因股骨头坏死行髋关节置换而退出。髋外侧分区组的术中X线透视次数、手术时间、术中钻孔次数、骨折愈合时间的评价结果均优于传统组[(10.5±2.3)次,(25.4±7.3)次,t=7.657,P=0.011;(41.7±5.6)min,(55.7±15.6)min,t=4.576,P=0.015;(4.5±1.2)次,(14.5±2.1)次,t=16.756,P=0.021;(5.6±1.5)个月,(7.0±0.6)个月,t=5.987,P=0.032]。2组患者末次随访时的Harris髋关节评分比较,差异无统计学意义[(90.3±2.7)分,(90.1±1.2)分,t=1.205,P=0.301]。结论:在股骨颈骨折经皮空心螺钉内固定术中,采用髋外侧分区法植入前置针辅助植入空心螺钉与凭经验植入空心螺钉相比,两者的髋关节功能恢复程度相当,但前者术中X线透视次数和钻孔次数少、手术时间和骨折愈合时间短。
Abstract:
Objective:To explore the applied value of pre-inserting a needle via lateral hip zoning method in the surgery of percutaneous hollow screw internal fixation for treatment of femoral neck fractures(FNFs).Methods:The medical records of 60 patients who underwent percutaneous hollow screw internal fixation for FNFs from March 2018 to March 2022 were analyzed retrospectively.The patients who received pre-insertion of a needle via lateral hip zoning method for assisting hollow screw implantation were assigned into the lateral hip zoning group,while the ones who underwent implantation of hollow screw based on the surgeon's experiences into the tradition group.The intraoperative X-ray exposure,operative time,intraoperative drilling times,fracture healing time and Harris hip score evaluated at the last follow-up were recorded and compared between the 2 groups.Results:One patient withdrew from each group due to undergoing hip replacement for femoral head necrosis.The results of evaluation on intraoperative X-ray exposure,operative time,intraoperative drilling times and fracture healing time were better in lateral hip zoning group compared to tradition group(10.5±2.3 vs 25.4±7.3 times,t=7.657,P=0.011; 41.7±5.6 vs 55.7±15.6 minutes,t=4.576,P=0.015; 4.5±1.2 vs 14.5±2.1 times,t=16.756,P=0.021; 5.6±1.5 vs 7.0±0.6 months,t=5.987,P=0.032); while,the comparison of Harris hip score evaluated at the last follow-up between the 2 groups revealed no significant differences(90.3±2.7 vs 90.1±1.2 points,t=1.205,P=0.301).Conclusion:Implantation of hollow screws assisted by pre-inserting a needle via lateral hip zoning method is similar to implantation of hollow screws based on the surgeon's experiences in the degree of hip function recovery in percutaneous hollow screw internal fixation for treatment of FNFs; while the former displays the advantages of fewer intraoperative X-ray exposure and intraoperative drilling,shorter operative time and fracture healing time compared to the latter.

参考文献/References:

[1] 张英泽.临床创伤骨科流行病学[M].2版.北京:人民卫生出版社,2014:178-179.
[2] 胡丹,范卫民.不同布局空心螺钉治疗股骨颈骨折的生物力学差异[J].江苏医药,2005,31(9):646-648.
[3] MASIONIS P,UVAROVAS V,MAZAREVICIUS G,et al.The reliability of a Garden,AO and simple II stage classifications for intracapsular hip fractures[J].Orthop Traumatol Surg Res,2019,105(1):29-33.
[4] 毛宾尧.髋关节外科学[M].北京:人民卫生出版社,1998:186-194.
[5] 陈世益,冯华.现代骨科运动医学[M].上海:复旦大学出版社,2020:781-784.
[6] 范克杰,陈柯,田可为,等.手法闭合复位联合平行螺钉和偏轴螺钉内固定治疗青壮年垂直不稳定型股骨颈骨折[J].中医正骨,2020,32(7):47-50.
[7] 高俊,颜晓静,张曦.孟河医学骨伤流派的正骨手法和治伤思想[J].中医正骨,2023,35(5):61-63.
[8] 李少帅,张宏军.PauwelsⅢ型股骨颈骨折内固定方式的选择及常见问题探讨[J].中医正骨,2018,30(11):57-59.
[9] 李英周,叶锋,万蕾,等.改良经皮加压钢板治疗Pauwels III型股骨颈骨折的疗效分析[J].中国骨伤,2018,31(2):120-123.
[10] 高博,吴碧,汪红,等.徒手置钉与机器人辅助置钉治疗股骨颈骨折的临床疗效对比[J].华西医学,2021,36(10):1344-1348.
[11] ZHU Z D,XIAO C W,TAN B,et al.TiRobot-assisted percutaneous cannulated screw fixation in the treatment of femoral neck fractures:a minimum 2-year follow-up of 50 patients[J].Orthop Surg,2021,13(1):244-252.
[12] 陈金雄,周观明,陈希聪,等.机器人辅助经皮空心钉固定股骨颈骨折[J].中国矫形外科杂志,2023,31(4):295-299.
[13] DUAN S J,LIU H S,WU W C,et al.Robot-assisted percutaneous cannulated screw fixation of femoral neck fractures:preliminary clinical results[J].Orthop Surg,2019,11(1):34-41.
[14] HE M,HAN W,ZHAO C P,et al.Evaluation of a Bi-planar robot navigation system for insertion of cannulated screws in femoral neck fractures[J].Orthop Surg,2019,11(3):373-379.
[15] WANG X D,LAN H,LI K N.Treatment of femoral neck fractures with cannulated screw invasive internal fixation assisted by orthopaedic surgery robot positioning system[J].Orthop Surg,2019,11(5):864-872.
[16] WAN L,ZHANG X,WU D,et al.Application of robot positioning for cannulated screw internal fixation in the treatment of femoral neck fracture:retrospective study[J].JMIR Med Inform,2021,9(1):e24164.
[17] YIN W,XU H,XU P,et al.A novel guidewire aiming device to improve the accuracy of guidewire insertion in femoral neck fracture surgery using cannulated screw fixation[J].Med Sci Monit,2016,22:2893-2899.
[18] 任步方,吕欣,马全平,等.应用自制股骨颈内固定导向器置入空心螺钉治疗股骨颈骨折的临床效果[J].中华外科杂志,2023,61(3):239-243.
[19] 王清泽,罗明星,曾帅,等.3D打印经皮手术导板在股骨颈骨折闭合复位空心螺钉内固定术中的应用[J].中国骨伤,2023,36(3):209-215.
[20] 接健,陈福扬,徐国浩,等.解剖学和影像学测量股骨头颈直径比的比较研究[J].中国骨与关节损伤杂志,2015,30(6):566-568.
[21] 刘俊俊,付建国,柳威,等.三角稳定固定系统对股骨颈骨折生物力学特性的有限元分析[J].中国医学物理学杂志,2021,38(7):893-897.
[22] 王子凡,缪佳庆.空心钉F形内固定骨质疏松性PauwelsⅡ型股骨颈骨折的体外生物力学研究[J].中国骨与关节损伤杂志,2020,35(2):153-155.
[23] WANG G,TANG Y,WANG B,et al.Minimally invasive open reduction combined with proximal femoral hollow locking plate in the treatment of Pauwels type III femoral neck fracture[J].J Int Med Res,2019,47(7):3050-3060.
[24] 袁剑锋,朱求亮,史本功.股骨颈内固定螺钉构型的解剖影像分析[J].解剖学报,2020,51(3):420-424.
[25] 孙亚超,白文哲,孙小辉,等.3枚空心加压螺钉在股骨颈截面的位置分布[J].临床骨科杂志,2021,24(6):895-898.
[26] 周雪锋,杨家赵,李黎,等.C臂X线机不同投射角度透视对股骨颈骨折经皮内固定后上方in-out-in螺钉的评估[J].中华解剖与临床杂志,2022,27(10):679-683.
[27] 卢海燕,唐聪,范华强,等.前方小切口辅助复位空心钉内固定治疗Garden Ⅲ、Ⅳ型股骨颈骨折[J].中国骨与关节损伤杂志,2017,32(7):715-717.
[28] 中华医学会骨科学分会创伤骨科学组,中国医师协会骨科医师分会创伤专家工作委员会.成人股骨颈骨折诊治指南[J].中华创伤骨科杂志,2018,20(11):921-928.
[29] 杨晓强,薛继钊,郑程,等.青壮年股骨颈骨折的内固定治疗进展[J].中医正骨,2021,33(7):38-44.
[30] 张忠良,林俊宏,费霖莉.代谢综合征对股骨颈骨折空心螺钉内固定术预后的影响[J].中医正骨,2020,32(4):21-25.
[31] 顾勇,赵艳明,童培建,等.基于数据挖掘法探讨中药复方治疗股骨头坏死的组方规律[J].中医正骨,2021,33(6):49-53.

相似文献/References:

[1]温超海,何忠,李永斌,等.闭合复位伽玛钉改良成锁定支架内固定治疗 老年股骨转子间骨折[J].中医正骨,2015,27(11):32.
[2]肖善富,张喜善,于凤珍.髌下小切口钢丝纽扣式内固定治疗胫骨髁间隆突骨折[J].中医正骨,2015,27(11):34.
[3]朱峰,宋相建,吴蔚,等.手法复位经皮克氏针内固定治疗 儿童闭合性肱骨远端全骨骺分离[J].中医正骨,2015,27(11):51.
[4]裘人华,胡培阳,裘天强,等.闭合复位外固定架固定治疗Colles骨折[J].中医正骨,2015,27(11):59.
[5]葛波涌,王玉波,王明太,等.交锁髓内钉内固定治疗胫骨干骨折的临床研究[J].中医正骨,2015,27(10):8.
 GE Boyong,WANG Yubo,WANG Mingtai,et al.Clinical study on the internal fixation with interlocking intramedullary nail for the treatment of tibial shaft fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(03):8.
[6]邓红敏,刘志诚.转子间斜行截骨结合股骨近端防旋髓内钉固定治疗 股骨近端骨折术后髋内翻畸形[J].中医正骨,2015,27(10):17.
[7]孙群周,阮成群,李光明,等.股骨近端防旋髓内钉内固定治疗 老年不稳定型股骨转子间骨折[J].中医正骨,2015,27(10):20.
[8]方策,倪新宇,王宏伟,等.迟氏正骨手法复位单臂外固定支架固定治疗 老年股骨转子间骨折[J].中医正骨,2015,27(10):22.
[9]全先辉,万春友,刘磊,等.Taylor空间支架外固定治疗胫腓骨开放性骨折[J].中医正骨,2015,27(10):30.
[10]茆军,张惠法,严培军,等.Ilizarov外固定支架结合克氏针固定治疗Pilon骨折[J].中医正骨,2015,27(10):32.
[11]刘震,胡志国,付伟.抖牵旋按复位结合钢针撬拨复位空心钉内固定治疗 难复性股骨颈骨折[J].中医正骨,2015,27(08):28.
[12]林统,徐强,包海燕.闭合复位经皮空心加压螺钉内固定联合口服中药 治疗股骨颈骨折[J].中医正骨,2015,27(07):61.
[13]陈武林,阮成群.缝匠肌肌蒂髂骨骨瓣移植联合股骨近端外侧锁定钢板固定治疗青壮年股骨颈骨折不愈合[J].中医正骨,2017,29(02):41.
[14]严卫锋,曾忠友,裴斐.髋关节直接前方入路切开复位空心加压螺钉内固定治疗难复位性股骨颈骨折[J].中医正骨,2017,29(09):45.
[15]王斌,钟浩博,杨剑锋.3种内固定治疗PauwelsⅢ型股骨颈骨折的生物力学研究[J].中医正骨,2018,30(07):6.
 WANG Bin,ZHONG Haobo,YANG Jianfeng.A biomechanical study of three kinds of internal fixation for treatment of Pauwels typeⅢfemoral neck fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(03):6.
[16]李少帅,张宏军.PauwelsⅢ型股骨颈骨折内固定方式的选择及常见问题探讨[J].中医正骨,2018,30(11):57.
[17]王淼鑫,袁西岐,郑作超,等.股骨近端锁定钛板内固定治疗股骨颈骨折[J].中医正骨,2018,30(11):68.
[18]张忠良,林俊宏,费霖莉.代谢综合征对股骨颈骨折空心螺钉内固定术预后的影响[J].中医正骨,2020,32(04):21.
 ZHANG Zhongliang,LIN Junhong,FEI Linli.Effects of metabolic syndrome on prognosis of patients who received surgery of hollow screw internal fixation for femoral neck fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2020,32(03):21.
[19]范克杰,陈柯,田可为,等.手法闭合复位联合平行螺钉和偏轴螺钉内固定治疗青壮年垂直不稳定型股骨颈骨折[J].中医正骨,2020,32(07):47.
[20]丁强,刘玉峰,苏艺,等.克氏针与空心螺钉内固定治疗儿童DelbetⅡ、Ⅲ型股骨颈骨折[J].中医正骨,2020,32(11):69.

备注/Memo

备注/Memo:
通讯作者:王定 E-mail:king_spring@163.com
更新日期/Last Update: 1900-01-01