Abstract：Objective: To design the hollow nail internal fixation channel and operation navigation device for the patients with femoral neck fracture before operation, and discussed its application value by 3D printing navigation internal fixation technology. Methods: 86 cases with femoral neck fracture admitted in our hospital from January 2015 to June 2017 were randomly divided into the observation group and the control group, with 43 cases in each group. All cases were treated with closed reduction and cannulated screw internal fixation. Patients in the control group received routine operation scheme, while for patients in the observation group, nail path position and navigator were designed by preoperative 3D printing navigation fixation technology. The basic indexes of surgery, postoperative screw distribution, Harris hip function score at 3 and 12 months after surgery, fracture healing status at the end following-up were observed and compared in 2 groups. Results: The duration from admitting to surgery and the duration of surgery in the observation group were much longer than those in the control group, the amount of bleeding during surgery in the observation group was much more than that in the control group, the times of fluoroscopy and of nail piercing in the observation group were much less than those in the control group, the differences were statistically significant (P＜ 0.05). The parallel degree of screws at front and side in the observation group were significantly lower than that in the control group, and the ratio of screw distribution area in the observation group was significantly higher than that in the control group (P＜ 0.05). At 3 months after operation, the Harris hip function score in the observation group was much better than it in the control group (P＜ 0.05). There were no significant differences in Harris hip function score between the two groups at 12 months after operation (P＞ 0.05). There was no significant difference in incidence of fracture nonunion, femoral head necrosis, Garden indexes and Harris hip function score at the end of following-up (P＞ 0.05). Conclusion: Nail path position and navigator designed by preoperative 3D printing navigation fixation technology can effectively guide cannulated screw internal fixation for patients with femoral neck fracture. It can reduce the frequency of fluoroscopy and of nail piercing, and will not increase the risk of adverse prognosis. It helps patients perform functional exercises as early as possible.
[1] Florschutz AV, Langford JR, Haidukewych GJ, et al. Femoral neck fractures: current management [J].Orthop Trauma, 2015, 29(3): 121~129. [2] 徐斌,王群,金华,等.空心钉内固定和关节置换术治疗移位型股骨颈骨折的成本效用分析[J].中华医学杂志,2017,97(21):1650~1654. [3] 陈旭,余正希,陈宣煌,等.3D打印数字化导航模块辅助股骨颈中空拉力螺钉的精准置入[J].中国组织工程研究,2016,20(53):7979~7984. [4] Papakostidis C, Panagiotopoulos A, Piccioli A, et al. Timing of internal fixation of femoral neck fractures. a systematic review and meta-analysis of the final outcome [J]. Injury, 2015, 46(3): 459~466. [5] 童祎,罗晓中,吴刚,等.机器人导航下及传统经皮空心拉力螺钉内固定术治疗股骨颈骨折的疗效比较[J].中国修复重建外科杂志,2016,30(6):685~689. [6] 张施展,张卫国,汪阳,等.髋关节镜辅助下复位联合空心钉内固定治疗青壮年移位型股骨颈骨折[J].骨科,2018,9(4):296~301. [7] Siavashi B, Aalirezaei A, Moosavi M, et al. A comparative study between multiple cannulated screws and dynamic hip screw for fixation of femoral neck fracture in adults [J]. IntOrthop, 2015, 39(10): 2069~2071. [8] Shields E, Kates SL. Revision rates and cumulative financial burden in patients treated with hemiarthroplasty compared to cannulated screws after femoral neck fractures [J]. Arch Orthop Trauma Surg, 2014, 134(12): 1667~1671. [9] 王飞,刘志斌,张建华,等.3D打印导航模板在辅助寰枢椎椎弓根螺钉置入中的应用价值[J].中国脊柱脊髓杂志,2017,27(1):61~68. [10] Zheng SN, Yao QQ, Mao FY, et al. Application of 3D printing rapid prototyping-assisted percutaneous fixation in the treatment of intertrochanteric fracture [J]. Exp Ther Med, 2017, 14(4): 3644~3650. [11] 郑朋飞,唐凯,王黎明,等.3D打印个体化手术导航模板在儿童股骨颈骨折中的应用[J].中华实用儿科临床杂志,2016,31(11):863~866.
2020, Vol. 26 
冀公网安备13080202000786号