摘要
目的探讨数字化O臂导航三维成像联合空心钉内固定治疗老年创伤性股骨颈骨折的临床疗效。方法前瞻性分析2018年2月—2019年9月佛山市中医院收治的创伤性股骨颈骨折老年患者126例,男性54例,女性72例;年龄65~84岁,平均72.5岁;致伤原因摔伤61例,道路交通伤65例。随机数字法分为研究组与对照组各63例。研究组行数字化O臂导航三维成像联合空心钉内固定治疗,对照组常规X线透视引导下行空心钉内固定治疗。比较两组患者一般资料、围术期指标、骨折愈合时间、髋关节功能、空心钉与股骨颈轴线夹角度、再手术率及术后并发症(骨折愈合迁延、股骨头缺血性坏死、骨折不愈合、股骨头缺血性坏死、尿路感染等)。结果研究组卧床时间、手术时间、出血量、透视时间、透视次数均少于对照组(11.1±1.2)d vs.(12.5±1.0)d、(29.5±7.5)min vs.(52.4±7.5)min、(76.5±6.5)mL vs.(99.5±5.5)mL、(21.4±3.7)s vs.(28.5±5.5)s、(5.3±1.9)次vs.(6.5±1.5)次,P<0.05;研究组再次手术率及移位率低于对照组但差异无统计学意义(2%vs.11%、2%vs.8%,P>0.05);研究组术后空心钉与股骨颈轴线夹角度正位、侧位均低于对照组(5.0±1.4)°vs.(7.8±1.5)°、(5.4±1.7)°vs.(8.6±1.4)°,P<0.05;研究组术后1、3、6、12个月髋关节功能评分均高于对照组(49.6±7.5)分vs.(46.2±8.2)分、(63.5±7.5)分vs.(58.5±6.8)分、(75.2±6.5)分vs.(70.2±5.2)分、(87.1±6.3)分vs.(84.9±6.4)分,P<0.05;研究组并发症发生率显著低于对照组(3%vs.16%,P<0.05)。结论数字化O臂导航三维成像联合空心钉内固定治疗老年创伤性股骨颈骨折可缩短患者卧床时间、手术时间,减少出血量、透视时间、透视次数,降低并发症发生率,值得推广应用。
Objective To investigate the effect of 3D image O-arm based navigation system guided cannulated screw internal fixation in the treatment of senile traumatic femoral neck fracture.Methods A total of 126 elderly patients with traumatic femoral neck fracture in Foshan City Hospital of Traditional Chinese Medicine from Feb.2018 to Sep.2019 were prospectively enrolled,including 54 males and 72 females,aged from 65 to 84 years,with an average of 72.5 years;Cause-of-injury analysis showed 61 cases of falling injury and 65 cases of traffic accident injury.Patients were divided into two groups by random number methods,each with 63 cases.Study group received 3D image O-arm based navigation system guided cannulated screw internal fixation,while control group received conventional X-ray fluoroscopy guided cannulated screw internal fixation.Both operations were in line with the treatment of traumatic femoral neck fracture in the elderly.Then various indexes were compared between groups,including general data,perioperative indicators,fracture healing time,hip joint function,angle of cannulated nail and femoral neck axis,reoperation rate and postoperative complications(delayed fracture healing,avascular necrosis of femoral head,nonunion,avascular necrosis of femoral head,urinary tract infection,etc).Results The in-bed time,operation time,blood loss,fluoroscopy time and fluoroscopy frequency of the study group were less than those of the control group[(11.1±1.2)d vs.(12.5±1.0)d,(29.5±7.5)minutes vs.(52.4±7.5)minutes,(76.5±6.5)mL vs.(99.5±5.5)mL,(21.4±3.7)s vs.(28.5±5.5)s,(5.3±1.9)times vs.(6.5±1.5)times],P<0.05.The rate of reoperation and displacement in the study group was slightly lower than that in the control group[2%vs.11%,2%vs.8%],P>0.05.The anteroposterior and lateral angles of cannulated nail and femoral neck axis were lower in the study group than those in the control group[(5.0±1.4)°vs.(7.8±1.5)°,(5.4±1.7)°vs.(8.6±1.4)°],P<0.05.The hip function scores in the study group were higher than those in the control group at 1,3,6 and 12 months after surgery[(49.6±7.5)points vs.(46.2±8.2)points,(63.5±7.5)points vs.(58.5±6.8)points,(75.2±6.5)points vs.(70.2±5.2)points,(87.1±6.3)points vs.(84.9±6.4)points,P<0.05].The complication rate was 3%in the study group,which was significantly lower than 15%in the control group,P<0.05.Conclusion Application of 3D image O-arm based navigation system guided cannulated screw internal fixation in the treatment of senile traumatic femoral neck fracture can shorten the in-bed time and operation time,reduce the amount of blood loss,fluoroscopy time,fluoroscopy frequency,complication rate,which is worthy of promotion and application.
作者
陈慧婷
蔡剑
陈金雄
Chen Huiting;Cai Jian;Chen Jinxiong(Tenth Branch of Orthopedics Department,Foshan City Hospital of Traditional Chinese Medicine,Foshan,Guangdong 528099,China)
出处
《创伤外科杂志》
2021年第11期837-840,共4页
Journal of Traumatic Surgery
关键词
创伤性股骨颈骨折
数字化O臂导航
三维成像
空心钉
内固定
老年
traumatic femoral neck fracture
3D image O-arm based navigation
three-dimensional imaging
cannulated screw
internal fixation
elderly
作者简介
通信作者:蔡剑,E-mail:1695179501@qq.com。
