CAJ | 학술논문

目的探讨二维导航技术在髋部骨折内固定手术中的应用价值. 方法回顾性分析2006年5月至2009年10月应用二维导航引导内固定治疗的28例髋部骨折患者资料,根据骨折类型不同分为两组:股骨颈骨折组13例,男8例,女5例;平均年龄为(54.5±7.3)岁;骨折Garden分型:Ⅱ型3例,Ⅲ型8例,Ⅳ型2例.股骨转子间骨折组15例,男7例,女8例;平均年龄为(74.5±9.6)岁;骨折按Evens-Jensen分型:ⅠB型2例,ⅡA型7例,ⅡB型4例,Ⅲ型2例.记录两组患者的手术时间、术中出血量、透视次数、切口长度、骨折愈合时间及末次随访时髋关节Harris评分等,并与各自未应用导航技术的对照组进行比较. 结果 28例患者术后获12 ～24个月(平均18个月)随访.股骨颈骨折组患者的透视次数[(3.3±1.1)次]显著少于对照组患者[(9.1±3.1)次],差异有统计学意义(P＜0.05);而两组患者的手术时间、术中出血量、骨折愈合时间及末次随访时髋关节Harris评分比较差异均无统计学意义(P＞0.05).股骨转子间骨折组患者的术中出血量[(100.1±7.9)mL]、透视次数[(4.3±1.0)次]显著少于对照组患者[(207.2±10.5) mL、(6.5±1.3)次],切口长度[(4.8±0.7)cm]显著短于对照组患者[(5.6±1.6)cm],末次随访时髋关节Harris评分[(82.1±8.8)分]显著高于对照组患者[(76.3±9.4)分],差异均有统计学意义(P＜0.05);而两组患者的手术时间和骨折愈合时间比较差异均无统计学意义(P＞ 0.05). 结论二维导航引导内固定治疗髋部骨折能明显提高手术效率,保证内固定的准确性,减少手术和放射性损伤.
목적 탐토이유도항기술재관부골절내고정수술중적응용개치. 방법 회고성분석2006년5월지2009년10월응용이유도항인도내고정치료적28례관부골절환자자료,근거골절류형불동분위량조:고골경골절조13례,남8례,녀5례;평균년령위(54.5±7.3)세;골절Garden분형:Ⅱ형3례,Ⅲ형8례,Ⅳ형2례.고골전자간골절조15례,남7례,녀8례;평균년령위(74.5±9.6)세;골절안Evens-Jensen분형:ⅠB형2례,ⅡA형7례,ⅡB형4례,Ⅲ형2례.기록량조환자적수술시간、술중출혈량、투시차수、절구장도、골절유합시간급말차수방시관관절Harris평분등,병여각자미응용도항기술적대조조진행비교. 결과 28례환자술후획12 ～24개월(평균18개월)수방.고골경골절조환자적투시차수[(3.3±1.1)차]현저소우대조조환자[(9.1±3.1)차],차이유통계학의의(P＜0.05);이량조환자적수술시간、술중출혈량、골절유합시간급말차수방시관관절Harris평분비교차이균무통계학의의(P＞0.05).고골전자간골절조환자적술중출혈량[(100.1±7.9)mL]、투시차수[(4.3±1.0)차]현저소우대조조환자[(207.2±10.5) mL、(6.5±1.3)차],절구장도[(4.8±0.7)cm]현저단우대조조환자[(5.6±1.6)cm],말차수방시관관절Harris평분[(82.1±8.8)분]현저고우대조조환자[(76.3±9.4)분],차이균유통계학의의(P＜0.05);이량조환자적수술시간화골절유합시간비교차이균무통계학의의(P＞ 0.05). 결론 이유도항인도내고정치료관부골절능명현제고수술효솔,보증내고정적준학성,감소수술화방사성손상.
Objective To investigate application of two-dimensional navigation in internal fixation of hip fractures.Methods From May 2006 to October 2009,we used two-dimensional navigation technique to assist internal fixation in 28 patients with hip fractures.There were 13 cases of femoral neck fractures.They were 8 males and 5 females,with an average age of 54.5 ± 7.3 years.By Garden classification,3 of them were type Ⅱ,8 type Ⅲ and 2 type Ⅳ.There were 15 cases of intertrochanteric fractures.They were 7 males and 8 females,with an average age of 74.5 ± 9.6 years.By Evens-Jensen classification,2 of them were type ⅠB,7 type ⅡA,4 type ⅡB and 2 type Ⅲ.Both groups were compared respectively with their control groups which did not use navigation technique to assist internal fixation in terms of operation time,intraoperative blood loss,fluoroscopy frequency,incision length,healing time,Harris hip score and postoperative complications.Results Postoperative X-ray films showed all the implants were inserted accurately.All the 28 patients obtained follow-up from 12 to 24 months (average,18 months).For the group of femoral neck fractures,the fluoroscopy frequency (3.3 ± 1.1 times) was significantly lower than that for its control group (9.1 ± 3.1 times) (P ＜ 0.05),but there were no significant differences between the 2 groups in operation time,intraoperative blood loss,healing time,or Harris hip score at the last follow-up (P ＞ 0.05).For the group of intertrochanteric fractures,intraoperative blood loss (100.1 ± 7.9 mL) was significantly less,fluoroscopy frequency (4.3 ± 1.0 times) significantly lower,incision length (4.8 ±0.7 cm) significantly shorter,and Harris hip score at the last follow-up (82.1 ± 8.8) significantly higher than those for its control group (207.2±10.5 mL,6.5±1.3 times,5.6±1.6cmand76.3±9.4,respectively) (P ＜0.05),but there were no significant differences between the 2 groups in operation time or healing time (P ＞ 0.05).Conclusion Application of two-dimensional navigation in internal fixation of hip fractures can improve surgical efficiency by ensuring high fixation accuracy and reducing operative invasion and radiation exposure.