目的 探讨计算机导航系统辅助置入空心螺钉内固定术治疗股骨颈骨折的安全性及疗效。 方法 选取本院2017年1月至2020年7月采用空心螺钉内固定术治疗股骨颈骨折患者59例，根据是否用计算机手术导航系统分为导航组29例，非导航组30例，比较两组术中出血量、透视次数、钻孔次数、总手术时间、术中人员流动情况及术后患者正侧位X线片任意2枚螺钉的夹角、2枚最远距离的螺钉在股骨颈的离散程度等指标。 结果 导航组术中出血量、透视次数、导针钻孔次数、总手术时间及手术相关人员出入人次均少于非导航组，差异均有统计学意义（P<0.05），患者术后正侧位X线片任意2枚螺钉的夹角及2枚最远距离螺钉在股骨颈的离散程度优于非导航组，差异均有统计学意义（P<0.05）。 结论 计算机导航系统辅助置入空心螺钉内固定术治疗股骨颈骨折安全精准，值得推广实践。
Abstract
Objective To evaluate the clinical effects of computerized navigation system assisted the placement of the cannulated screw and internal fixation for the treatment of femoral neck fractures. Methods Fifty-nine patients diagnosed with femoral neck fracture and treated with cannulated screw internal fixation from January 2017 to July 2020 were selected. All the patients were divided into a navigation group (n=29) and a non-navigation group (n=30) according to whether using Medtronic computer surgical navigation system (S7) or not. The intraoperative blood loss, times of intraoperative fluoroscopy, times of guide needle drilling, total operation time, persons’ movement frequency during operation of the two groups were compared. The average angles of any two screws and the dispersion degree of the two screws with the farthest distance in the femoral neck on the postoperative anteroposterior and lateral X-ray films of the two groups were recorded and compared. Results Compared with non-navigation group, there were less intraoperative blood loss, shorter total operation time, less usages of intraoperative fluoroscopy, fewer guide needle drilling and less persons’ movement frequency during operation of the navigation group. There were statistical significances in intraoperative blood loss, total operation time, usages of intraoperative fluoroscopy, guide needle drilling and persons’ movement frequency during operation between the two groups (P<0.05). The average angles of any two screws and the dispersion degree of the two screws with the farthest distance in the femoral neck on the postoperative anteroposterior and lateral X-ray films of the navigation group were better than those in the non-navigation group (P<0.05). There were statistical significances in the above two indexes between the two groups. Conclusions It is safe and accurate to insert cannulated screws for the treatment of femoral neck fracture with the aid of the computer navigation system. It is worthy of promotion and practice.
关键词
股骨颈骨折； /
/
计算机辅助； /
/
骨折内固定； /
/
导航系统
Key words
Femoral neck fracture /
Computer assisted /
Internal fixation of fracture /
Navigation system
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Cooper C, Campion G, Melton 3rd LJ. Hip fractures in the elderly: a world-wide projection[J]. Osteoporos Int, 1992, 2(6): 285-289. DOI: 10.1007/BF01623184.
[2] Bhandari M, Swiontkowski M. Management of acute hip fracture[J]. N Engl J Med, 2017, 377(21): 2053-2062. DOI: 10.1056/NEJMcp1611 090.
[3] 张英泽. 股骨骨折[M]//张英泽. 临床创伤骨科流行病学. 北京: 人民卫生出版社, 2014: 177-179.
[4] Slobogean GP, Sprague SA, Scott T, et al. Complications following young femoral neck fractures[J]. Injury, 2015, 46(3): 484-491. DOI: 10.1016/j.injury.2014.10.010.
[5] 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. DOI: 10.3760/cma.j.issn.1671-7600. 2018. 11.001.
[6] S Terry Canale, James H Beaty (王岩主译). 坎贝尔骨科手术学. 10版[M]. 济南: 山东科学技术出版社, 2006: 2796-2797.
[7] Mayman D, Vasarhelyi EM, Long W, et al. Computer-assisted guidewire insertion for hip fracture fixation[J]. J Orthop Trauma, 2005, 19(9): 610-615. DOI: 10.1097/01.bot.0000177106.30837.28.
[8] 黄波, 荣绍远, 李建华, 等. 双平面机器人导航辅助下空心钉内固定治疗股骨颈骨折[J]. 中华骨科杂志, 2017, 37(9): 528-534. DOI: 10.3760/cma.j.issn.0253-2352.2017.09.003.
[9] He M, Han W, Zhao CP, 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. DOI: 10.1111/os.12450.
[10]Gurusamy K, Parker MJ, Rowlands TK. The complications of displaced intracapsular fractures of the hip: the effect of screw positioning and angulation on fracture healing[J]. J Bone Joint Surg Br, 2005, 87(5): 632-634. DOI: 10.1302/0301-620X.87B5.15237.
[11]Selvan VT, Oakley MJ, Rangan A, et al. Optimum configuration of cannulated hip screws for the fixation of intracapsular hip fractures: a biomechanical study[J]. Injury, 2004, 35(2): 136-141. DOI: 10.1016/s0020-1383(03)00059-7.
[12]Wang JQ, Zhao CP, Su YG, et al. Computer-assisted navigation systems for insertion of cannulated screws in femoral neck fractures: a comparison of bi-planar robot navigation with optoelectronic navigation in a synbone hip model trial[J]. Chin Med J (Engl), 2011, 124(23): 3906-3911. DOI: 10.3760/cma.j.issn.0366-6999.2011.23.014.
[13]The 2007 recommendations of the international commission on radiological protection: ICRP publication 103[J]. Ann ICRP, 2007, 37(2-4): 1-332. DOI: 10.1016/j.icrp.2007.10.003.
[14]Pierce DA, Preston DL. Radiation-related cancer risks at low doses among atomic bomb survivors[J]. Radiat Res, 2000, 154(2): 178-186. DOI: 10.1667/0033-7587(2000)154[0178:rrcral]2.0.co;2.
[15]周海霞, 周海兰. 术中人员流动对手术室空气细菌动态变化及切口感染的影响[J]. 中华医院感染学杂志, 2017, 27(8), 1829-1831, 1836. DOI: 10.11816/cn.ni.2017-163328.
基金
国家自然科学基金面上项目（81871767）；深圳市医疗卫生“三名工程”高层次医学团队（SZSM201612019）；深圳市数字外科3D打印重点实验室（ZDSYS201707311542415）；南方医科大学临床研究启动项目（LC2016ZD036）；南方医科大学深圳医院苗苗培育计划（2018MM13）；广东省医学科研基金项目（B2021174）
PDF(4816 KB)
京ICP备08002354号-3
