基于精确三维测量股骨干骨折髓内钉内固定的数字化设计及临床应用

摘要

背景：传统的髓内钉手术的局限性在于依赖医生的个人经验，而且扩髓会导致髓腔内生物学环境的破坏，影响骨的愈合。目的：观察数字化技术辅助髓内钉内固定治疗股骨干骨折的疗效分析。方法：2010年1月至2014年1月莆田学院附属医院骨科收治股骨干骨折患者80例，均应用数字化技术辅助治疗，术前建立股骨干骨折的三维数字模型，对三维数字骨折端进行虚拟复位，测量髓腔的直径，按测量数据选取合适规格的髓内钉，然后按照数字化技术制定的手术方案进行闭合复位髓内钉内固定治疗。结果与结论：80例患者随访12-24个月，骨折全部获得骨愈合，随访12个月时按骨科临床疗效标准评价，优62例，良15例，可3例，优良率为96%。无感染、内固定物断裂或松动等并发症发生。提示，数字化技术辅助髓内钉内固定治疗股骨干骨折疗效确切，能明显缩短手术时间，减少手术创伤，减少患者和医护人员术中透视的放射量。%BACKGROUND:The limitation of the traditional intramedulary nailing relies on the personal experience of the doctor. Moreover, the enlargement of the bone marrow causes the destruction of the biological environment of the marrow cavity and affects the healing of bone. OBJECTIVE:To observe therapeutic effect of digital technology assisted intramedulary nail fixation for femoral shaft fracture. METHODS:A total of 80 patients with femoral shaft fracture, who were treated in the Department of Orthopedics, Affiliated Hospital of Putian University from January 2010 to January 2014, were enroled. Digital technology was used to assist treatment. Three-dimensional digital model of femoral shaft fracture was established before treatment. Virtual reduction was conducted in the three-dimensional digital fractures. The diameter of medulary cavity was measured. Appropriate specification of intramedulary nailing was selected according to the measurement data. Closed reduction and intramedulary nailing were performed according to operation scheme of digital technology. RESULTS AND CONCLUSION:The 80 patients were folowed up for 12 to 24 months. Fractures were completely healed. At 12 months after treatment, they were evaluated by clinical curative effect standard in department of orthopedics. There were excelent in 62 cases, good in 15 cases, and good in 3 cases, with the excelent and good rate of 96%. No complications occurred such as infection, fixator breakage or loosening. These results verify that digital technology assisted intramedulary nail fixation for femoral shaft fracture obtained positive therapeutic effects, could obviously shorten operation time, reduce surgical trauma, and diminish intraoperative X-ray emission to patients and health care workers.