股骨颈截面导向器的设计及应用

Design and application of guide device for femoral neck section

目的:探讨根据股骨颈截面解剖特点设计的一种辅助股骨颈多枚螺钉内固定新型导向器的应用效果。方法:自2016年10月至12月选取10具成年人20根干燥股骨标本,男7例,女3例;年龄37~58(47.5±7.5)岁。应用新型导向器及技术,以传统导向器技术为对照,置入3枚空心螺钉模拟治疗股骨颈骨折。记录比较两种方法的螺钉定位精度参数和螺钉穿刺次数、螺钉平行度、手术时间及透视次数。结果:20例标本成功置入60枚螺钉。螺钉平行度、手术时间和术中透视次数两种方法差异无统计学意义(P>0.05)。螺钉距皮质距离、螺钉距股骨颈截面中心距离、螺钉与股骨颈截面面积比、螺钉间距离、螺钉穿刺次数两种方法间差异有统计学意义(P<0.05),说明应用新型导向器在定位螺钉精度及减少穿刺次数方面比传统方法更有优势。结论:二维透视下使用新型导向器及经皮穿刺技术与传统技术比较,股骨颈骨折内固定螺钉定位更佳。

Objective:To explore the application effect of a new guide device designed according to the anatomical characteristics of the femoral neck cross section to assist the internal fixation of multiple screw of the femoral neck. Methods:From October to December 2016,10 adult dry femur specimens,including 7 males and 3 females,aged 37 to 58(47.5±7.5) years old,were selected. Three hollow screws were implanted to simulate the treatment of femoral neck fracture with the new guider technology and the traditional guider technology as the control. The screw location accuracy parameters,screw puncture times,screw parallelism,operation time and fluoroscopy times of the two methods were recorded and compared. Results:Sixty screws were successfully implanted in 20 specimens. There was no significant difference in screw parallelism,operation time and fluoroscopy times between the two methods(P>0.05). There were significant differences in the distance between screw and cortex,the distance between screw and femoral neck,the area ratio between screw and femoral neck,the distance between screws and the number of screw punctures between two methods(P<0.05). It showed that the new type of guide had more advantages than the traditional method in locating screw accuracy and reducing the number of punctures. Conclusion:Compared with the traditional technique,the new guider and percutaneous puncture technique under two-dimensional fluoroscopy have better localization of internal fixation screw for femoral neck fracture.