平乐正骨手法复位结合3D打印导航内固定治疗青壮年股骨颈骨折的临床研究

发布时间：2018-11-09 11:20

【摘要】：目的:本研究运用平乐正骨手法对不稳定型股骨颈骨折患者进行闭合复位;利用计算机设计符合患者的个性化3D打印导航,通过导航将空心钉呈倒等腰三角形打入股骨头内,观察平乐正骨手法结合3D打印导航治疗青壮年不稳定型股骨颈骨折的临床疗效。方法:根据纳入、排除标准纳入30例患者,按随机数字表法将患者随机分为两组,治疗组与对照组各15例。治疗组:术前根据患者CT数据设计并打印个性化导航,术中在G型臂透视下,采用平乐正骨手法闭合复位,由一位高年资医师利用3D打印个性化导航将空心钉呈倒等腰三角形打入股骨头内;对照组:术中在G型臂透视下,采用平乐正骨手法闭合复位,由同一位高年资医师将空心钉呈倒等腰三角形打入股骨头内。分别记录两组患者术中出血量、透视次数、手术时间,术后一周行DR检查,并根据DR分析Garden指数,以及空心钉是否按倒等腰三角形排列,术后3个月、6个月评估患者Harri`s评分并行DR检查,根据骨折愈合标准评定骨折愈合情况。根据SPSS13.0软件对结果进行统计,并探讨该治疗方法的优缺点。结果:治疗组患者手术时间64.53±12.47(min),与对照组49.80±16.23(min)比有统计学差异(P0.05);治疗组术中出血量91.34±9.9(ml),明显多于对照组27.34±13.35(ml),有明显统计学差异(P0.01);治疗组术中透视次数21.4±3.33(次)明显低于对照组48.74±4.98(次),有明显统计学差异(P0.01);治疗组穿针次数11.67±3.43(次),明显少于对照组28.47±3.78(次),有明显统计学差异(P0.01);术后Garden指数治疗组13例Garden I级,2例Garden II级与对照组12例Garden I级,3例Garden II级对比无明显统计学差异(P0.05);空心钉排列情况,治疗组13例呈平行倒等腰三角形排列,2例呈非平行倒等腰三角形排列,对照组9例呈平行倒等腰三角形排列,6例呈非平行倒等腰三角形排列两组之间无明显统计学差异(P0.05);治疗组术后3个月骨折愈合13例,2例未愈合,对照组愈合10例,5例未愈合,两组之间无明显统计学差异(P0.05);治疗组术后6个月骨折愈合14例,1例未愈合,对照组愈合13例,2例未愈合,两组之间无明显统计学差异(P0.05);术后3个月治疗组与对照组患者Harri`s评分对比无明显差异(P0.05);术后6个月治疗组与对照组患者Harri`s评分对比无明显差异(P0.05)。结论:应用平乐正骨手法对移位型股骨颈骨折进行复位,效果良好。使用个性化3D打印导航能够准确快速的将空心钉成平行倒等腰三角形打入股骨颈内,减少可能由于多次穿针对患者导致的医源性创伤,降低对手术医师水平的要求,减少由于X线造成的职业损害。
[Abstract]:Objective: to study the closed reduction of unstable femoral neck fracture with Pingle's bony manipulation. The computer was used to design the personalized 3D printing navigation for the patient. The hollow nail was presented as an inverted isosceles triangle into the femoral head through the navigation. To observe the clinical effect of the treatment of unstable femoral neck fracture with Pingle bony manipulation and 3 D printing navigation. Methods: according to the inclusion and exclusion criteria, 30 patients were randomly divided into two groups, 15 cases in the treatment group and 15 cases in the control group. In the treatment group, preoperative CT data were used to design and print personalized navigation. A senior physician made use of 3D printing personalized navigation to put the hollow nail into the femoral head with an inverted isosceles triangle. In the control group, under G-arm fluoroscopy, Pingle orthopedic bone manipulation was used to close reduction, and the hollow nail was inserted into the femoral head with the same senior medical practitioner as an inverted isosceles triangle. The amount of intraoperative bleeding, the times of fluoroscopy, the time of operation, the DR examination one week after operation were recorded, and the Garden index was analyzed according to DR, and whether the hollow nails were arranged according to the inverted isosceles triangle, 3 months after operation. Harri's score was evaluated at 6 months and DR was performed. Fracture healing was assessed according to fracture healing criteria. The results were statistically analyzed by SPSS13.0 software, and the advantages and disadvantages of the treatment were discussed. Results: the operative time of the patients in the treatment group was 64.53 卤12.47 (min), and that in the control group was 49.80 卤16.23 (min) (P0.05). The amount of intraoperative bleeding in the treatment group was significantly higher than that in the control group (91.34 卤9.9 (ml), vs 27.34 卤13.35 (ml), P0.01). The times of fluoroscopy in the treatment group (21.4 卤3.33 times) were significantly lower than that in the control group (48.74 卤4.98 times) (P0.01). The times of needle puncture in the treatment group were 11.67 卤3.43 times, which were significantly lower than that in the control group 28.47 卤3.78 times (P0.01). There were 13 cases of Garden I in Garden index treatment group, 2 cases of Garden II grade and 12 cases of Garden I grade in control group. There was no significant difference in Garden II grade in 3 cases (P0.05). In the treatment group, 13 cases were arranged as parallel inverted isosceles triangle, 2 cases as non-parallel inverted isosceles triangle, and 9 cases in control group as parallel inverted isosceles triangle. There was no significant difference between the two groups (P0.05). In the treatment group, 13 cases were healed 3 months after operation, 2 cases were not healed, 10 cases were healed in the control group, 5 cases were not healed, there was no significant difference between the two groups (P0.05). There were 14 cases of fracture healing 6 months after operation in the treatment group and 13 cases in the control group and 2 cases in the control group. There was no significant difference between the two groups (P0.05). There was no significant difference in Harri's score between the treatment group and the control group 3 months after operation (P0.05), but there was no significant difference in the Harri's score between the treatment group and the control group 6 months after operation (P0.05). Conclusion: the effect of reduction of displaced femoral neck fracture with Pingle's bony manipulation is good. The use of personalized 3D printing navigation can accurately and quickly insert hollow nails into the neck of the femur into parallel inverted isosceles triangles, reduce the iatrogenic trauma that may be caused by multiple needle piercing, and reduce the requirements for the surgeon's level. Reduce occupational damage due to X-rays.
【学位授予单位】：河南中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R274.1

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