[1]宛磊,张世魁,吴大龙,等.CT三维重建和手术模拟辅助股骨近端防旋髓内钉内固定治疗老年股骨转子间骨折的临床研究[J].中医正骨,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.
点击复制

CT三维重建和手术模拟辅助股骨近端防旋髓内钉内固定治疗老年股骨转子间骨折的临床研究()
分享到：

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第34卷
期数:
2022年02期
页码:
7-11
栏目:
临床研究
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; 张世魁; 吴大龙; 岳龙; 于蒙洋; 单文亚; 李智浩; 张绍安
漯河医学高等专科学校第二附属医院,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
关键词:
髋骨折;  股骨;  转子间骨折;  老年人;  成像; 三维;  手术模拟;  股骨近端防旋髓内钉;  骨折固定术; 内;  临床试验
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:探讨CT三维重建和手术模拟辅助股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)内固定治疗老年股骨转子间骨折的临床疗效和安全性。方法:纳入117例老年股骨转子间骨折患者,随机分为辅助治疗组和常规治疗组。辅助治疗组在术前常规CT检查后,将CT扫描原始数据导入Mimics医学影像处理软件进行三维重建,并模拟PFNA内固定手术; 常规治疗组在术前常规CT检查后,不进行三维重建和手术模拟。2组患者均采用PFNA内固定治疗。比较2组患者的一次置钉成功率、手术时间、术中出血量、住院时间、Harris髋关节评分及并发症发生率。结果:①一般结果。辅助治疗组58例,术中一次置钉成功47例; 常规治疗组59例,术中一次置钉成功33例; 辅助治疗组患者一次置钉成功率高于常规治疗组(χ2=8.523,P=0.004); 辅助治疗组患者手术时间短于常规治疗组[(86.3±10.7)min,(121.5±11.6)min,t=17.053,P=0.000],术中出血量少于常规治疗组[(247.8±22.5)mL,(286.9±17.8)mL,t=10.434,P=0.000]; 2组患者住院时间比较,差异无统计学意义[(10.3±2.6)d,(10.7±2.2)d,t=0.899,P=0.371]。②Harris髋关节评分。时间因素和分组因素不存在交互效应(F=0.161,P=0.527); 2组患者Harris髋关节评分比较,组间差异无统计学意义,即不存在分组效应(F=1.031,P=0.375); 手术前后不同时间点Harris髋关节评分的差异有统计学意义,即存在时间效应(F=38.754,P=0.000); 术前、术后6个月、术后12个月,2组患者Harris髋关节评分均呈上升趋势,且2组的上升趋势完全一致[(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并发症发生率。辅助治疗组患者均未发生术中螺钉穿出、髋内翻畸形、下肢短缩等并发症,常规治疗组1例患者发生下肢短缩。2组患者并发症发生率比较,差异无统计学意义(χ2=0.992,P=0.319)。结论:CT三维重建和手术模拟辅助PFNA内固定治疗老年股骨转子间骨折与PFNA内固定比较,临床疗效和安全性相当,但前者的一次置钉成功率高、手术时间短、术中出血少。
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.

参考文献/References:

[1] 张红英,王芳平.针对性护理对老年股骨转子间骨折患者髋关节置换术疗效的影响[J].海军医学杂志,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,游镇君,蒋毅.快速康复外科理念在老年股骨转子间骨折围手术期治疗中的应用[J].中医正骨,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] 强敏菲,陈雁西,张坤,等.计算机辅助术前计划在老年股骨转子间骨折治疗中的应用价值[J].中华骨科杂志,2017,37(17):1061-1068.
[9] 中华中医药学会.中医骨伤科常见病诊疗指南[M].北京:中国中医药出版社,2012:154-157.
[10] 蒋协远,王大伟.骨科临床疗效评价标准[M].北京:人民卫生出版社,2005:132-134.
[11] 刘志雄.骨科常用诊断分类方法和功能结果评定标准[M].北京:北京科学技术出版社,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] 杨晶.计算机辅助设计3D打印技术在复杂跟骨骨折治疗中的应用[J].国际骨科学杂志,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] 江孝龙,蒋国华,孙贤杰.股骨近端防旋髓内钉内固定与动力髋螺钉内固定治疗老年股骨转子间骨折的对比研究[J].中医正骨,2019,31(2):8-13.
[22] 王郑浩,李开南.基于CT三维重建技术绘制骨折地图的临床应用进展[J].中华创伤骨科杂志,2020,22(2):175-179.
[23] 吴发财,杨东辉,陈琦,等.CT三维重建在股骨转子间骨折分型中的应用[J].中国CT和MRI杂志,2018,16(11):140-143.
[24] 吴晓东,独行业,周正明.计算机辅助设计数字化钢板固定治疗髋臼后壁骨折伴髋关节脱位[J].中华创伤骨科杂志,2018,20(5):439-442.
[25] 夏铁男,商冠宁.3D打印技术在骨科应用现状的研究进展[J].中华实用诊断与治疗杂志,2020,34(7):742-744.

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]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.
[3]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.
[4]赵云昌.人工股骨头置换治疗老年粉碎性股骨转子间骨折[J].中医正骨,2015,27(08):31.
[5]姜自伟,黄枫,郑晓辉,等.老年股骨转子间骨折患者的围手术期风险评估与控制[J].中医正骨,2015,27(08):33.
[6]倪新宇,方策.外固定器治疗股骨转子间骨折的研究进展[J].中医正骨,2015,27(07):48.
[7]张明强.生物型加长柄半髋关节置换术治疗 高龄不稳定股骨转子间骨折疗效观察[J].中医正骨,2015,27(02):56.
[8]李书良,李启义,李建明,等.锁定钢板内固定联合自体髂骨植骨治疗 股骨近端粉碎性骨折[J].中医正骨,2015,27(05):31.
[9]王智勇,陈柯,田可为,等.联合应用摇杆技术和钳夹技术微创治疗股骨转子部骨折[J].中医正骨,2015,27(05):36.
[10]郑艳峰,吴勋,周荣昌,等.股骨近端防旋髓内钉内固定与动力髋螺钉内固定治疗 老年股骨转子间骨折的对比研究[J].中医正骨,2015,27(04):24.
　ZHENG Yanfeng,WU Xun,ZHOU Rongchang,et al.A comparative study of proximal femoral nail antirotation internal fixation versus dynamic hip screw internal fixation for treatment of intertrochanteric fractures in the aged[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(02):24.
[11]张威,赵士君,李翔,等.改良“糖果包扎”钢丝内固定联合股骨近端防旋髓内钉内固定治疗老年A2型股骨转子间骨折的临床研究[J].中医正骨,2021,33(10):23.
　ZHANG Wei,ZHAO Shijun,LI Xiang,et al.A clinical study of modified candy-package wire internal fixation combined with proximal femoral nail antirotation internal fixation for treatment of type A2 femoral intertrochanteric fractures in the aged[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2021,33(02):23.

备注/Memo

备注/Memo:
基金项目:河南省医学科技攻关计划项目(LHGJ20200880)
更新日期/Last Update: 2022-02-20