基于虚拟设计髓内钉钢板固定A2-3型股骨粗隆间骨折△（开放获取）

Proximal femoral nail anti-rotation combined buttress plate based on preoperative visual design for type A2-3 femoral intertrochanteric fracture (OA)

摘要:

[目的]探讨 Mimics 辅助虚拟设计股骨近端髓钉内联合锁定钢板固定 A2-3 型股骨粗隆间骨折的临床疗效。[方法] 回顾性分析 2018 年 1 月—2021 年 6 月本院创伤骨科采用开放复位内固定（open reduction and internal fixation, ORIF）治疗的 53 例 A2-3 型股骨粗隆间骨折患者的临床资料。根据医患沟通结果，28 例依据术前 Mimics 软件辅助设计行 ORIF （设计组），25 例未选择辅助设计，行常规 ORIF（常规组）。比较两组围手术期、随访及影像结果。[结果]设计组手术时间 [(52.7±5.2) min vs (69.5±7.1) min, P＜0.001]、术中出血量 [(102.7±10.9) ml vs (165.9±10.7) ml, P＜0.001]、术中透视次数 [(8.3±2.1) 次 vs (10.2±3.5) 次, P=0.018] 均显著优于常规组。设计组完全负重时间 [(36.3±5.8) d vs (47.5±6.3) d, P＜0.001] 显著早于常规组。术后随时间推移，两组 Harris 评分、髋伸屈 ROM、髋内外旋 ROM 均显著增加（P＜0.05），术后 1、6 个月，设计组髋关节上述临床指标均显著优于常规组（P＜0.05）。影像方面，两组患者骨折复位质量优良率的差异无统计学意义（P＞0.05）。至末次随访时，设计组的颈干角 （neck-shaft angle, NSA） 无变化，而常规组 NSA 显著减小 （P＜0.05）。末次随访时，设计组在尖-顶距 （tip-apex distance, TAD） 及股骨头颈短缩值均显著优于常规组（P＜0.05）。[结论]对累及外侧壁的股骨粗隆间骨折，术前虚拟辅助设计能够为术者提供精准的分型和个体化的固定方案，缩短手术时间，减少内固定失效的发生率。

Abstract:

[Objective] To evaluate the clinical significance of preoperative Mimics-assisted design of proximal femoral nail anti-rotation (PFNA) combined with buttress plate fixation of type A2-3 femoral intertrochanteric fractures. [Methods] A retrospective analysis was performed on 53 patients who received open reduction and internal fixation (ORIF) with PFNA and buttress plate for type A2-3 femoral intertrochanteric fractures in our hospital from January 2018 to June 2021. According to the preoperative doctor-patient communication, 28 patients had ORIF performed based on preoperative design with Mimics software, while other 25 patients had routine ORIF conducted without preoperative digital design (routine group). The documents regarding to perioperative period, follow-up and images were compared between the two groups. [Results] The design group proved significantly superior to the routine groups in terms of operation time [(52.7±5.2) min vs (69.5±7.1) min, P＜0.001], intraoperative blood loss [(102.7±10.9) ml vs (165.9±10.7) ml, P＜0.001], intraoperative fluoroscopy times [(8.3±2.1) times vs (10.2±3.5) times, P=0.018]. In addition, the design group resumed full loading activity significantly earlier than that of the routine group [(36.3±5.8) days vs (47.5±6.3) days, P＜0.001]. The Harris score, hip extension-flexion ROM and internal-external rotation ROM significantly increased in both groups over time (P＜0.05), which were significantly better in the design group than the routine group at 1 month and 6 months after surgery. With respect of imaging, there was no statistically significant difference in the fracture reduction quality between the two groups (P＞0.05). The design group had the neck-shaft angle (NSA) remained unchanged, whereas the routine group had NSA significantly decreased by the latest followup (P＜0.05). At corresponding time points after surgery, the design group proved significantly better than the routine group in tip-apex distance (TAD) and femoral head and neck shortening (P＜0.05). [Conclusion] For femoral intertrochanteric fractures involving the lateral wall, preoperative virtual design with virtual reconstruction provides the surgeon with accurate classification and individualized fixation plan, shorten the operation time and reduce the incidence of internal fixation failure.