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目的 探讨3D打印技术联合股骨近端防旋髓内钉（PFNA）治疗外侧壁破裂型股骨粗隆间骨折临床效果及并发症。方法 回顾性分析2020年1月至2024年10月收治的外侧壁破裂型股骨粗隆间骨折患者118例的临床资料，根据治疗方案的不同分为常规组（n=57）和3D组（n=61），常规组采用PFNA治疗，3D组采用3D打印技术联合PFNA治疗。对比两组围术期指标（手术时间、术中出血量、骨折愈合时间、下床时间、住院时间、术中X线透视次数）、髋部功能[Harris髋关节功能评分（HHS）]、尖顶距、颈干角及并发症情况。结果 3D组手术时间、骨折愈合时间、下床时间、住院时间短于常规组，术中出血量和术中X线透视次数少于常规组（P<0.01）。3D组术中复位满意度[95.08%(58/61)]高于常规组[82.46%(47/57)]，差异有统计学意义（P<0.01）。术后3个月，3D组各项（功能、疼痛、活动范围和肢体畸形）HHS评分均较常规组高（P<0.01）。术后3个月，3D组尖顶距低于常规组，颈干角大于常规组（P<0.01）。3D组并发症总发生率[16.39%(10/61)]低于常规组[31.58%(18/57)]，差异有统计学意义（P<0.05）。结论 3D打印技术联合PFNA应用于外侧壁破裂型股骨粗隆间骨折患者中的效果更佳，有助于缩短骨折愈合时间，提高术中复位满意度，恢复髋关节功能，维持合适的尖顶距、颈干角，降低并发症发生率。
Abstract：Objective To explore the clinical effect of 3D printing technology combined with proximal femoral nail antirotation(PFNA) in the treatment of lateral wall ruptured intertrochanteric fractures of the femur. Methods A retrospective analysis was conducted on the clinical data of 118 patients with lateral wall ruptured intertrochanteric fractures of the femur admitted from January 2020 to October 2024. They were divided into the conventional group(n=57) and the 3D group(n=61) according to different treatment plans. The conventional group was treated with PFNA, and the 3D group was treated with 3D printing technology combined with PFNA. The perioperative indicators(duration of operation, intraoperative blood loss, fracture healing time, time to off-bed activity, length of hospital stay, and the number of intraoperative X-ray fluoroscopy), hip function [Harris Hip Function Score(HHS)], tip-apex distance(TAD), neck-shaft angle(NSA) and complications were compared between the two groups. Results The duration of operation, fracture healing time, time to off-bed activity and length of hospital stay in the 3D group were shorter than those in the conventional group, while intraoperative blood loss and the number of intraoperative X-ray fluoroscopy in the 3D group were less than those in the conventional group(P<0.01). The intraoperative reduction satisfaction rate in the 3D group was higher than that in the conventional group [95.08%(58/61) vs.82.46%(47/57)], showing significant difference(P<0.01). At 3 months after operation, the HHS scores of each item(function,pain, range of motion and limb deformity) in the 3D group were all higher than those in the conventional group(P<0.01). At 3 months after operation, TAD in the 3D group was lower than that in the conventional group, while the NSA was greater than that in the conventional group(P<0.01). The total incidence of complications in the 3D group [16.39%(10/61)] was lower than that in the conventional group [31.58%(18/57)], and the difference was statistically significant(P<0.05). Conclusion The application of 3D printing technology combined with PFNA in patients with lateral wall ruptured intertrochanteric fractures of the femur has a better effect. It helps to shorten the fracture healing time, improve the satisfaction of intraoperative reduction,restore hip joint function, maintain an appropriate TAD and NSA, and reduce the incidence of complications.
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基本信息:
DOI：
中图分类号:R687.3
引用信息:
[1]程爱民,单清洁,刘文龙等.3D打印技术联合股骨近端防旋髓内钉治疗外侧壁破裂型股骨粗隆间骨折临床效果及并发症分析[J].临床误诊误治,2025,38(12):58-62+67.
基金信息:
国家自然科学基金委员会资助项目（81373802）; 安徽中医药大学临床科研项目（2023LCTH03）