摘要
探讨计算机辅助术前计划（computer assisted pre-operation plan, CAPP）在老年股骨转子间骨折治疗中的应用价值。方法 回顾性分析2012年3月至2015年6月,应用PFNA-Ⅱ治疗127例老年股骨转子间骨折患者资料。根据是否行精准术前设计分为2组：CAPP组（53例;年龄60~92岁,平均75.3岁;EvansⅠb型12例,Ⅰc型9例,Ⅰd型15例,Ⅱ型17例）,非CAPP组（74例;年龄62~95岁,平均76.6岁;EvansⅠb型18例,Ⅰc型15例,Ⅰd型20例,Ⅱ型21例）。记录术前计划所需时间,观察术前计划在术中的实现应用情况,比较两组患者的手术时间、术中出血量、术中透视次数、住院天数,采用Harris评分评估患者末次随访时的髋关节功能。结果 CAPP组术前总耗时平均24.7 min,术中实施情况与计算机辅助术前设计方案吻合率为100%。CAPP组平均手术时间为（46.8±6.5） min、术中透视次数为（12.0±2.3）次、术中出血量为（154.4±27.6） ml,均低于非CAPP组的（57.8±10.3） min、（20.9±3.2）次、（235.0±65.8） ml,两者比较差异均有统计学意义。CAPP组平均住院（13.9±1.3） d,非CAPP组为（14.3±1.4） d,两组比较无明显差异。术后CAPP组45例患者获平均18.3个月随访;非CAPP组50例获平均19.2个月随访。末次随访时CAPP组患者的Harris髋关节功能评分为84~96分,平均（88.6±2.8）分;非CAPP组为80~95分,平均（87.5±3.2）分;两者比较差异无统计学意义。结论 CAPP可协助临床医生完成术前设计,使得PFNA-Ⅱ治疗老年股骨转子间骨折的手术操作更加精准、高效、缩短手术时间、减少手术创伤,提高围手术期的安全性,并获得满意的手术疗效。
Objective To discuss the curative effect of computer assisted pre-operation plan （CAPP） in treating the geriatric intertrochanteric femoral fracture. Methods The data of intertrochanteric fractures treated with PFNA-II between March 2012 and June 2015 were retrospectively analyzed. They were divided into two groups by preoperative design. One group was the CAPP group consisting of 53 patients with a mean age of 75.3 years （range, 60-92 years）. According to the Evans Classification, there were 12 Evans type Ib, 9 Evans type Ic, 15 Evans type Id and 17 Evans type II fractures. The other group was the non-CAPP group consisting of 74 patients with a mean age of 76.6 years （range, 62-95 years）. There were 18 Evans type Ib, 15 Evans type Ic, 20 Evans type Id and 21 Evans type II fractures. Operation time, intraoperative blood loss, times of fluoroscopy during operation and days of hospital stay were compared. The hip joint function was evaluated by Harris score at the final follow-up. Results The CAPP meanly cost 24.7 min. The consistency of the surgery and CAPP was up to 100%. In the CAPP group, the average operation time was 46.8±6.5 min; the average times of fluoroscopy during operation were 12.0±2.3 times; and the average blood loss was 154.4±27.6 ml. In the non-CAPP group, the average operation time was 57.8±10.3 min; the average times of fluoroscopy during operation was 20.9±3.2; and the average blood loss was 235.0±65.8 ml. All above data in the CAPP group were significantly lower than those in the non-CAPP group. The mean days of hospital stay were 13.9±1.3 days in the CAPP group and 14.3±1.4 days in non-CAPP group. The days of hospital stay had no significant difference between the two groups. Forty-five patients with an average follow-up period of 18.3 months were reviewed in the CAPP group. Fifty patients were followed up with an average period of 19.2 months in the non-CAPP group. At the final follow-up, the average Harris score was 88.6±2.8 points （range, 84-96 points） in the CAPP group and 87.5±3.2 points （range, 80-95 points） in the non-CAPP group. Conclusion CAPP system is convenient and efficient. It can facilitate the treatment of intertrochanteric fracture effectively.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2017年第17期1061-1068,共8页
Chinese Journal of Orthopaedics
关键词
髋
骨折
骨折固定术
内
计算机辅助设计
成像
三维
wHip
Fractures, bone
Fracture fixation, internal
Computer-aided design
Imaging, three-dimensional
