基于误差纠正算法的计算机辅助股骨颈骨折空心螺钉内固定系统的临床应用研究

Clinical application of computer-assisted cannulated screw internal fixation system based on error correction method for femoral neck fractures

目的探讨基于误差纠正算法的计算机辅助股骨颈骨折空心螺钉内固定系统的临床应用价值。方法回顾性分析2014年1月—2015年10月,采用基于误差纠正算法的计算机辅助股骨颈骨折空心螺钉内固定系统完成股骨颈骨折闭合复位空心螺钉内固定术的20例患者临床资料(试验组),并与同期采用传统徒手植钉法完成手术的36例患者(对照组)进行比较。两组患者性别、年龄、致伤原因、骨折侧别、骨折类型、受伤至手术时间等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。比较两组手术时间、术中出血量、术中透视次数、术中钻入导针次数、骨折愈合时间、骨折愈合率以及髋关节Harris评分。结果两组术后切口均Ⅰ期愈合,无神经、血管损伤等并发症发生。试验组手术时间较对照组显著延长(t=2.290,P=0.026),但术中出血量、术中透视次数、术中钻入导针次数均较对照组显著降低,比较差异有统计学意义(t=–10.650,P=0.000;t=18.320,P=0.000;t=–16.625,P=0.000)。所有患者术后均获随访,随访时间12~18个月,平均14.7个月。X线片复查示,两组骨折均愈合,且骨折愈合时间比较差异无统计学意义(t=0.208,P=0.836);随访期间无股骨头缺血性坏死等并发症发生。末次随访时,试验组髋关节Harris评分为(87.05±3.12)分,对照组为(86.78±2.83)分,比较差异无统计学意义(t=0.333,P=0.741)。结论与传统徒手植钉手术相比,采用基于误差纠正算法的计算机辅助股骨颈骨折空心螺钉内固定系统辅助手术在减少术中辐射、减小手术创伤等方面具有一定优势。

Objective To investigate the clinical efficacy of computer-assisted cannulated screw internal fixation system based on error correction method for femoral neck fractures. Methods A retrospective analysis was made on the clinical data of 20 femoral neck fracture patients treated by computer-assisted cannulated screw internal fixation system based on error correction method between January 2014 and October 2015 （trial group）, and 36 femoral neck fracture patients undergoing traditional manual surgery with closed reduction by cannulated screw fixation in the same period （the control group）. There was no significant difference in gender, age, injury cause, side of fracture, types of fracture, and time from injury to operation between 2 groups （P〉0.05）. The operation time, intraoperative blood loss, intraoperative frequency of fluoroscopy and guide pin insertion, fracture healing time, fracture healing rate, and Harris hip score were compared between 2 groups. Results All incisions healed by first intention after operation, and no complication of blood vessel and nerve injury occurred. The operation time of trial group was significantly longer than that of control group（t=2.290, P=0.026）, however, the intraoperative blood loss, intraoperative frequency of fluoroscopy and guide pin insertion of trial group were significantly less than those of control group （t=-10.650, P=0.000; t=18.320, P=0.000; t=-16.625, P=0.000）. All patients were followed up 12-18 months （mean, 14.7 months）. X-ray films showed that fracture healing was obtained in 2 groups, showing no significant difference in fracture healing time between 2 groups （t=0.208, P=0.836）. No complication of ischemic necrosis of femoral head occurred during follow-up period. At last follow-up, the Harris hip score was 87.05±3.12 in trial group and was 86.78±2.83 in control group, showing no significant difference （t=0.333, P=0.741）. Conclusion Computer-assisted cannulated screw internal fixation surgery based on error correction method for femoral neck fractures is better than traditional manual surgery in decreasing intraoperative radiation and surgical trauma during operation.