平樂正骨手法復位結(jié)合3D打印導航內(nèi)固定治療青壯年股骨頸骨折的臨床研究
發(fā)布時間：2018-11-09 11:20
【摘要】：目的:本研究運用平樂正骨手法對不穩(wěn)定型股骨頸骨折患者進行閉合復位;利用計算機設(shè)計符合患者的個性化3D打印導航,通過導航將空心釘呈倒等腰三角形打入股骨頭內(nèi),觀察平樂正骨手法結(jié)合3D打印導航治療青壯年不穩(wěn)定型股骨頸骨折的臨床療效。方法:根據(jù)納入、排除標準納入30例患者,按隨機數(shù)字表法將患者隨機分為兩組,治療組與對照組各15例。治療組:術(shù)前根據(jù)患者CT數(shù)據(jù)設(shè)計并打印個性化導航,術(shù)中在G型臂透視下,采用平樂正骨手法閉合復位,由一位高年資醫(yī)師利用3D打印個性化導航將空心釘呈倒等腰三角形打入股骨頭內(nèi);對照組:術(shù)中在G型臂透視下,采用平樂正骨手法閉合復位,由同一位高年資醫(yī)師將空心釘呈倒等腰三角形打入股骨頭內(nèi)。分別記錄兩組患者術(shù)中出血量、透視次數(shù)、手術(shù)時間,術(shù)后一周行DR檢查,并根據(jù)DR分析Garden指數(shù),以及空心釘是否按倒等腰三角形排列,術(shù)后3個月、6個月評估患者Harri`s評分并行DR檢查,根據(jù)骨折愈合標準評定骨折愈合情況。根據(jù)SPSS13.0軟件對結(jié)果進行統(tǒng)計,并探討該治療方法的優(yōu)缺點。結(jié)果:治療組患者手術(shù)時間64.53±12.47(min),與對照組49.80±16.23(min)比有統(tǒng)計學差異(P0.05);治療組術(shù)中出血量91.34±9.9(ml),明顯多于對照組27.34±13.35(ml),有明顯統(tǒng)計學差異(P0.01);治療組術(shù)中透視次數(shù)21.4±3.33(次)明顯低于對照組48.74±4.98(次),有明顯統(tǒng)計學差異(P0.01);治療組穿針次數(shù)11.67±3.43(次),明顯少于對照組28.47±3.78(次),有明顯統(tǒng)計學差異(P0.01);術(shù)后Garden指數(shù)治療組13例Garden I級,2例Garden II級與對照組12例Garden I級,3例Garden II級對比無明顯統(tǒng)計學差異(P0.05);空心釘排列情況,治療組13例呈平行倒等腰三角形排列,2例呈非平行倒等腰三角形排列,對照組9例呈平行倒等腰三角形排列,6例呈非平行倒等腰三角形排列兩組之間無明顯統(tǒng)計學差異(P0.05);治療組術(shù)后3個月骨折愈合13例,2例未愈合,對照組愈合10例,5例未愈合,兩組之間無明顯統(tǒng)計學差異(P0.05);治療組術(shù)后6個月骨折愈合14例,1例未愈合,對照組愈合13例,2例未愈合,兩組之間無明顯統(tǒng)計學差異(P0.05);術(shù)后3個月治療組與對照組患者Harri`s評分對比無明顯差異(P0.05);術(shù)后6個月治療組與對照組患者Harri`s評分對比無明顯差異(P0.05)。結(jié)論:應(yīng)用平樂正骨手法對移位型股骨頸骨折進行復位,效果良好。使用個性化3D打印導航能夠準確快速的將空心釘成平行倒等腰三角形打入股骨頸內(nèi),減少可能由于多次穿針對患者導致的醫(yī)源性創(chuàng)傷,降低對手術(shù)醫(yī)師水平的要求,減少由于X線造成的職業(yè)損害。
[Abstract]:Objective: to study the closed reduction of unstable femoral neck fracture with Pingle's bony manipulation. The computer was used to design the personalized 3D printing navigation for the patient. The hollow nail was presented as an inverted isosceles triangle into the femoral head through the navigation. To observe the clinical effect of the treatment of unstable femoral neck fracture with Pingle bony manipulation and 3 D printing navigation. Methods: according to the inclusion and exclusion criteria, 30 patients were randomly divided into two groups, 15 cases in the treatment group and 15 cases in the control group. In the treatment group, preoperative CT data were used to design and print personalized navigation. A senior physician made use of 3D printing personalized navigation to put the hollow nail into the femoral head with an inverted isosceles triangle. In the control group, under G-arm fluoroscopy, Pingle orthopedic bone manipulation was used to close reduction, and the hollow nail was inserted into the femoral head with the same senior medical practitioner as an inverted isosceles triangle. The amount of intraoperative bleeding, the times of fluoroscopy, the time of operation, the DR examination one week after operation were recorded, and the Garden index was analyzed according to DR, and whether the hollow nails were arranged according to the inverted isosceles triangle, 3 months after operation. Harri's score was evaluated at 6 months and DR was performed. Fracture healing was assessed according to fracture healing criteria. The results were statistically analyzed by SPSS13.0 software, and the advantages and disadvantages of the treatment were discussed. Results: the operative time of the patients in the treatment group was 64.53 鹵12.47 (min), and that in the control group was 49.80 鹵16.23 (min) (P0.05). The amount of intraoperative bleeding in the treatment group was significantly higher than that in the control group (91.34 鹵9.9 (ml), vs 27.34 鹵13.35 (ml), P0.01). The times of fluoroscopy in the treatment group (21.4 鹵3.33 times) were significantly lower than that in the control group (48.74 鹵4.98 times) (P0.01). The times of needle puncture in the treatment group were 11.67 鹵3.43 times, which were significantly lower than that in the control group 28.47 鹵3.78 times (P0.01). There were 13 cases of Garden I in Garden index treatment group, 2 cases of Garden II grade and 12 cases of Garden I grade in control group. There was no significant difference in Garden II grade in 3 cases (P0.05). In the treatment group, 13 cases were arranged as parallel inverted isosceles triangle, 2 cases as non-parallel inverted isosceles triangle, and 9 cases in control group as parallel inverted isosceles triangle. There was no significant difference between the two groups (P0.05). In the treatment group, 13 cases were healed 3 months after operation, 2 cases were not healed, 10 cases were healed in the control group, 5 cases were not healed, there was no significant difference between the two groups (P0.05). There were 14 cases of fracture healing 6 months after operation in the treatment group and 13 cases in the control group and 2 cases in the control group. There was no significant difference between the two groups (P0.05). There was no significant difference in Harri's score between the treatment group and the control group 3 months after operation (P0.05), but there was no significant difference in the Harri's score between the treatment group and the control group 6 months after operation (P0.05). Conclusion: the effect of reduction of displaced femoral neck fracture with Pingle's bony manipulation is good. The use of personalized 3D printing navigation can accurately and quickly insert hollow nails into the neck of the femur into parallel inverted isosceles triangles, reduce the iatrogenic trauma that may be caused by multiple needle piercing, and reduce the requirements for the surgeon's level. Reduce occupational damage due to X-rays.
【學位授予單位】：河南中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R274.1
本文編號：2320254
[Abstract]:Objective: to study the closed reduction of unstable femoral neck fracture with Pingle's bony manipulation. The computer was used to design the personalized 3D printing navigation for the patient. The hollow nail was presented as an inverted isosceles triangle into the femoral head through the navigation. To observe the clinical effect of the treatment of unstable femoral neck fracture with Pingle bony manipulation and 3 D printing navigation. Methods: according to the inclusion and exclusion criteria, 30 patients were randomly divided into two groups, 15 cases in the treatment group and 15 cases in the control group. In the treatment group, preoperative CT data were used to design and print personalized navigation. A senior physician made use of 3D printing personalized navigation to put the hollow nail into the femoral head with an inverted isosceles triangle. In the control group, under G-arm fluoroscopy, Pingle orthopedic bone manipulation was used to close reduction, and the hollow nail was inserted into the femoral head with the same senior medical practitioner as an inverted isosceles triangle. The amount of intraoperative bleeding, the times of fluoroscopy, the time of operation, the DR examination one week after operation were recorded, and the Garden index was analyzed according to DR, and whether the hollow nails were arranged according to the inverted isosceles triangle, 3 months after operation. Harri's score was evaluated at 6 months and DR was performed. Fracture healing was assessed according to fracture healing criteria. The results were statistically analyzed by SPSS13.0 software, and the advantages and disadvantages of the treatment were discussed. Results: the operative time of the patients in the treatment group was 64.53 鹵12.47 (min), and that in the control group was 49.80 鹵16.23 (min) (P0.05). The amount of intraoperative bleeding in the treatment group was significantly higher than that in the control group (91.34 鹵9.9 (ml), vs 27.34 鹵13.35 (ml), P0.01). The times of fluoroscopy in the treatment group (21.4 鹵3.33 times) were significantly lower than that in the control group (48.74 鹵4.98 times) (P0.01). The times of needle puncture in the treatment group were 11.67 鹵3.43 times, which were significantly lower than that in the control group 28.47 鹵3.78 times (P0.01). There were 13 cases of Garden I in Garden index treatment group, 2 cases of Garden II grade and 12 cases of Garden I grade in control group. There was no significant difference in Garden II grade in 3 cases (P0.05). In the treatment group, 13 cases were arranged as parallel inverted isosceles triangle, 2 cases as non-parallel inverted isosceles triangle, and 9 cases in control group as parallel inverted isosceles triangle. There was no significant difference between the two groups (P0.05). In the treatment group, 13 cases were healed 3 months after operation, 2 cases were not healed, 10 cases were healed in the control group, 5 cases were not healed, there was no significant difference between the two groups (P0.05). There were 14 cases of fracture healing 6 months after operation in the treatment group and 13 cases in the control group and 2 cases in the control group. There was no significant difference between the two groups (P0.05). There was no significant difference in Harri's score between the treatment group and the control group 3 months after operation (P0.05), but there was no significant difference in the Harri's score between the treatment group and the control group 6 months after operation (P0.05). Conclusion: the effect of reduction of displaced femoral neck fracture with Pingle's bony manipulation is good. The use of personalized 3D printing navigation can accurately and quickly insert hollow nails into the neck of the femur into parallel inverted isosceles triangles, reduce the iatrogenic trauma that may be caused by multiple needle piercing, and reduce the requirements for the surgeon's level. Reduce occupational damage due to X-rays.
【學位授予單位】：河南中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R274.1
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