背景：对于骨科方面，数字化技术可以对骨折部位进行三维重建，可视下虚拟复位，这不仅可以术前规划手术路径，制定合理的手术方案，还可以对术后的预后进行一定的预测。目的：探讨采用防旋股骨近端髓内钉置入修复股骨转子间骨折患者应用数字化技术进行三维测量及术前设计的可行性及临床疗效。方法：选择2010年1月至2014年1月昌邑市人民医院收治的采用防旋股骨近端髓内钉修复股骨转子间骨折的患者80例，按照就诊顺序随机分为传统治疗组和三维设计组，每组40例。传统治疗组常规行防旋股骨近端髓内钉修复治疗，三维设计组在术前行CT薄层扫描，建立股骨全段数字三维模型，并应用技术手段对其模拟复位，测量髓腔长度及内径，选择规格合适的髓内钉，在此基础上制定修复方案并实施手术。分别记录2组患者的手术时间、术中出血量及术中输血量，并采用髋关节Harris评分对患者髋关节功能进行随访评估。结果与结论：①2组病例修复手术均获得成功，手术顺利，其中2组患者在手术时间、术中出血量、术中输血量方面比较差异有显著性意义(P<0.05)；在总住院时间方面比较差异无显著性意义(P>0.05)；②所有患者均获得随访，术后伤口均一期愈合，至研究结束时，未发现断钉，断棒情况发生；③至末次随访时，传统治疗组髋关节功能Harris评分优良率为95%，三维设计组为93%，2组优良率比较差异无显著性意义；④结果表明，应用数字化骨科技术对采用防旋股骨近端髓内钉修复股骨转子间骨折的患者进行术前三维测量及手术设计可明显缩短手术时间，有效改善髋关节功能。%BACKGROUND:For the department of orthopedics, digital technology can be used for a three-dimensional reconstruction of the fracture site, and visual virtual reset. This not only can preoperatively plan the operation path, make reasonable operation plan, but also can predict the prognosis after surgery. OBJECTIVE:To discuss the feasibility and clinical effect of digital technology for three-dimensional measurement and preoperative design in intertrochanteric fracture patients undergoing proximal femoral nail antirotation. METHODS:Eighty patients of intertrochanteric fractures, who underwent proximal femoral nail antirotation in the Changyi People’s Hospital from January 2010 to January 2014, were selected in this study. According to the order of visiting, they were randomly divided into traditional treatment group and three-dimensional design group, with 40 cases in each group. Patients in the traditional treatment group received proximal femoral nail antirotation. Patients in the three-dimensional design group received preoperative CT scan to establish the digital three-dimensional model of intact femur. The analog was reset by technology. The length and diameter of medul ary cavity were measured. The appropriate specifications of intramedul ary nail were selected. On this basis, the plan of the operation and implementation of operation were made. Operation time, intraoperative bleeding volume and blood transfusion were recorded in the two groups. Hip function was evaluated by hip Harris score. RESULTS AND CONCLUSION:(1) Operations in the two groups were successful. Significant differences in operation time, intraoperative bleeding volume and blood transfusion were determined between the two groups (P<0.05). No significant difference in length of stay was detected between the two groups (P>0.05). (2) Al patients were fol owed up. Postoperative wound was healed. Broken nail or broken rod was not found at the end of the study. (3) At the end of the fol ow-up, the excel ent and good rate of Harris hip score was 95%in the traditional treatment group and 93%in the three-dimensional design group;no significant difference was detected between the two groups. (4) Results suggested that the application of digital department of orthopedics technology for the treatment of intertrochanteric fracture of femur in patients with preoperative three-dimensional measurement and surgical design can significantly shorten the operation time and improve hip function.
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