【摘要】 目的探讨O臂导航在股骨颈骨折空心钉置钉中的疗效。方法将2015年2月至2018年2月我院收治的78例股骨颈骨折患者,按照随机数字表法分为导航辅助组和常规非导航组。导航辅助组39例,男23例,女16例;年龄为18～60岁;骨折Garden分型:II型7例,III型30例,IV型2例;致伤原因:摔伤19例,车祸伤20例。合并内科基础疾病:糖尿病4例,高血压病4例。常规非导航组39例,男25例,女14例;年龄为17～60岁;骨折Garden分型:II型8例,III型29例,IV型2例;致伤原因:摔伤21例,车祸伤18例。比较两组术中X线透视次数和时间、空心钉置入时间、术后X线片上空心钉与股骨颈轴线之间的角度、术后髋关节功能评分等指标。结果两组术后均获12～24个月(平均18个月)随访,导航辅助组手术时间为32～42 min,骨折愈合时间为3.5～6个月,末次随访时髋关节功能Harris评分为90～100分。常规非导航组手术时间为42～52 min,骨折愈合时间为3.6～6.0个月,末次随访时髋关节功能Harris评分为90～100分。导航辅助组及常规非导航组患者术中X线透视时间分别为平均(21.9±3.8) s和(39.6±8.6) s,透视次数分别为平均(5.4±2.0)次和(39.9±9.0)次,空心钉置入时间分别平均为(29.7±8.5) min和(52.6±8.8) min,空心钉与股骨颈轴线之间的角度分别平均为:正位(5.0±1.5)°和(7.9±1.6)°,侧位(5.5±1.8)°和(8.7±1.5)°,以上项目两组间比较差异均有统计学意义(P<0.05)。两组骨折愈合时间和髋关节功能Harris评分比较差异无统计学意义。结论 O臂导航辅助下空心钉内固定治疗股骨颈骨折,可提高置钉的精确度,减少术中X线透视次数,减少空心钉置入时间,提高临床疗效,值得推广应用。更多还原

【Abstract】 Objective To investigate the effect of O-arm navigation in the treatment of femoral neck fracture with cannulated screws.Methods From February 2015 to February 2018,78 cases of femoral neck fracture were randomly divided into navigation group and non-navigation.Navigation group (n=39):23 males and 16 females;aged 18-60 years;type II in 7 cases,type III in 30 cases and type IV in 2 cases according to Garden classification;19 cases of falling injury and 20 cases of traffic accident;4 cases of diabetes mellitus;4 cases of hypertension.Non-navigation group (n=39):25 males and 14 females;aged 17-60 years;type II in 8 cases,type III in 29 cases and type IV in 2 cases according to Garden classification;21 cases of falling injury and 18 cases of traffic accident.The frequence and time of X-ray fluoroscopy,cannulated screw placement time,the angle between the cannulated screw and axis of the femoral neck on post-operative X-ray film,and post-operative hip functions were compared between the two groups.Results All patients were followed up for 12-24 months (average:18 months).Navigation group:operation time was 32-42 minutes;fracture healing time was 3.5-6 months;Harris score of the hip was 90-100 at the last follow-up.Non-navigation group:operation time was 42-52 minutes;fracture healing time was 3.6-6 months;Harris score of the hip was 90-100 at the last follow-up.Significant differences were found in the average X-ray fluoroscopy time [(21.9±3.8) s vs.(39.6±8.6) s] and frequence [(5.4±2.0) vs.(39.9±9.0)],cannulated screw placement time [(29.7±8.5) min vs.(52.6±8.8) min],and the average angle between the cannulated screw and femoral neck axis [(5.0±1.5) ° vs.(7.9±1.6) ° in AP view and (5.5±1.8) ° vs.(8.7±1.5) ° in lateral view] between the navigation group and non-navigation group (P < 0.05).No significant differences in fracture healing time and Harris score of the hip was noted between the two groups.Conclusions Internal cannulated screw fixation assisted by O-arm navigation can improve the accuracy of screw placement,reduce the frequence of X-ray fluoroscopy during operation,and reduce the time of cannulated screw placement,which is worthy of clinical application.更多还原