个性化3D打印导向器空心钉固定股骨颈骨折

Cannulated screws placed with individualized 3D printed guider for internal fixation of femoral neck fracture

[目的]评价个性化3D打印模板引导空心钉置入固定股骨颈骨折的临床应用价值。[方法] 2018年6月~2019年12月,本院骨科收治的股骨颈骨折患者40例,随机分为两组。其中,20例采用个性化3D个性化导向器引导下空心钉置入(3D组),20例采用传统导向器引导置钉(常规组)。比较两组围手术期、随访和影像资料。[结果]两组患者均顺利手术,两组间手术切口长度比较差异无统计学意义(P>0.05),但3D组在手术时间、术中置导针次数及术中出血量均显著优于常规组(P<0.05)。40例患者随访时间18~27个月,平均(22.52±8.98)个月。随时间推移,两组患者的VAS评分显著减少(P<0.05),而Harris评分及关节活动范围显著增加(P<0.05)。相应时间点,两组间VAS评分、Harris评分和关节活动范围的差异均无统计学意义(P>0.05)。影像方面,3D组正位、侧位空心螺钉相互平行度以及空心钉分散度均显著优于常规组(P<0.05)。至末次随访时,两组患者骨折均愈合,无骨不连、关节僵硬等影像改变。[结论]个性化3D打印模板引导股骨颈骨折空心钉置钉可减少导针置入次数,缩短手术时间,减少术中出血量,提高螺钉相互平行度及分散度。

[Objective] To evaluate the clinical value of the individualized 3 D printed guider introduced cannulated screws for internal fixation of femoral neck fracture. [Methods] From June 2018 to December 2019, a total of 40 patients who were undergoing surgical treatment for femoral neck fracture were enrolled in this study, and divided randomly into two groups. Of them,20 patients had cannulated screws placed by the individualized 3 D printed guider, while the remaining 20 patients were by the conventional universal guider. The perioperative, follow-up and radiographic items were compared between the two group. [Results] All patients had operation finished successfully. Although no a statistical difference was noted between the two groups in incision length, the 3 D group proved significantly superior to the conventional group regarding operation time, intraoperative times of screw placement and intraoperative blood loss(P<0.05). All the 40 patients were followed up for 18 to 27 months with a mean of(22.52±8.98) months. As time went, the VAS score significantly decreased(P<0.05), whereas the Harris score, hip flexion and abduction range of motions(ROMs) significantly increased in both groups(P<0.05). However, there were no statistical differences in aforesaid parameters between the two groups at any corresponding time point(P>0.05). In term of radiographic evaluation, the 3 D group was significantly superior to the conventional group in parallelism and dispersity of the screws on anteroposterior and lateral views after operation(P<0.05). To the latest follow-up, all patients in both groups achieved bony healing of the fracture without signs of nonunion and hip ankylosis in anyone of them on radiographs. [Conclusion] This individualized 3 D printed guider does facilitate surgical operation with advantage of reducing times of screw placement, saving operation time, decreasing intraoperative blood loss and enhancing parallelism and dispersity of the screw placement.