股骨干骨折髓内钉固定三种远端锁定置入比较△

Comparison of three distal locking screw placement in intramedullary nailing fixation of femoral shaft fracture

摘要:

[目的] 对比采用常规机械式瞄准器、2 枚斯氏针透视技术及国产可视化电磁导航系统置入股骨髓内针远端锁钉的手术效能。 [方法] 回顾性分析 2018 年 1 月—2022 年 7 月采用交锁髓内针内固定治疗的 45 例成人股骨干骨折患者的临床资料。根据医患沟通结果将患者分为常规组（机械式瞄准器）、导针组（2 枚斯氏针透视技术）及导航组（可视化电磁导航）。每组 15 例。比较三组手术效能。[结果] 所有患者均顺利完成手术。常规组、导针组和导航组的手术时间为 [(150.5±39.5) min vs (118.3±31.4) min vs (113.3±29.5) min, P=0.008]，远端切口总长度 [(5.2±0.3) cm vs (4.0±0.3) cm vs (4.1±0.2) cm, P＜0.001]，远端锁钉时间 [(39.3±12.3) min vs (32.1±7.7) min vs (30.1±6.1) min, P=0.020]，远端锁钉透视次数 [(8.1±2.6) 次 vs (10.3±2.4) 次 vs (4.3±1.0) 次, P＜0.001]，远侧孔一次成功率 （66.7% vs 80.0% vs 100%, P=0.042）。术后 1 周常规组、导针组和导航组的 VAS 评分为 [(4.8±0.7) vs (3.7±0.7) vs (3.5±0.6), P＜0.001]，末次随访时，三组 VAS 评分的差异均无统计学意义（P＞0.05）。[结论]对比常规机械式瞄准器，2 枚斯氏针技术和国产可视化电磁导航系统均可提升手术效能，缩短远端螺钉置入时间和整体手术时间。

Abstract:

[Objective] To compare the surgical efficacy of distal locking screw placement among conventional mechanical guide (CMG), two pin fluoroscopy (TPF) and domestic visual electromagnetic navigation system (EMN). [Methods] A retrospective study was performed on 45 adult patients who received interlocking intramedullary nailing for femoral shaft fractures from January 2018 to July 2022. According to the doctor-patient communication, the patients were divided into a CMG, TPF and EMN groups, with 15 cases in each group. The operative efficacy of the three groups was compared. [Results] All patients in the 3 groups had operation performed successfully. The CMG, TPF and EMC group were recorded in terms of operation time [(150.5±39.5) min vs (118.3±31.4) min vs (113.3±29.5) min, P=0.008], total length of the distal incision [(5.2±0.3) cm vs (4.0±0.3) cm vs (4.1±0.2) cm, P＜0.001], distal locking time [(39.3±12.3) min vs (32.1±7.7) min vs (30.1±6.1) min, P=0.020], fluoroscopy times for distal locking [(8.1±2.6) times vs (10.3±2.4) times vs (4.3±1.0) times, P＜0.001], and the success rate of the first screw placement of the distal hole (66.7% vs 80.0% vs 100%, P=0.042). The VAS scores for pain of the CMG, TPF and EMC groups were [(4.8±0.7) vs (3.7±0.7) vs (3.5±0.6), P＜0.001] one week after surgery, while which became not statistically significant among the three groups at the latest follow-up (P＞0.05). [Conclusion] Compared with the conventional mechanical guide, both two pin fluoroscopy and visual electromagnetic navigation system do improve operation efficacy in shortening the time of distal screw placement and shortening the total operation time.