K Zhang, M Qiang, G Jia, X Jia, Z Yang, T Shi, Q Han, T Liu, Y Chen
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引用次数: 0
Abstract
Introduction: Long proximal femoral intramedullary nails present challenges in the treatment of subtrochanteric fractures. Short nails may represent a suitable alternative; however, conventional preoperative planning has limitations in evaluating their appropriateness. This study investigated whether computer-assisted virtual planning can enhance implant selection consistency, short nail utilisation, and surgical outcomes.
Methods: This retrospective cohort study analysed 103 patients (57 virtual planning, 46 conventional planning) treated with proximal femoral intramedullary nailing at a Level I trauma centre in China between 2009 and 2018. Conventional planning relied on imaging and surgeon experience. Virtual planning used three-dimensional computed tomography reconstruction to simulate fracture reduction and determine optimal implant dimensions. Primary outcomes were the planned and actual implant dimensions selected. Secondary outcomes included operative parameters, complications, implant-associated adverse events, and functional scores at 12 months. Robust multivariate analysis of covariance and logistic regression analyses were performed.
Results: Compared with conventional planning, virtual planning demonstrated higher consistency between planned and actual short/long nail selection (kappa coefficient=0.95 vs 0.54) and implant dimensions (intraclass correlation coefficient=0.889-0.971 vs 0.786-0.870), with a higher actual short nail utilisation rate (75.4% vs 52.2%). Virtual planning reduced operative duration (90.21 vs 141.67 minutes; P<0.001), closed reduction duration (23.02 vs 30.43 minutes; P<0.001), blood loss (203.51 vs 294.78 mL; P<0.001), and number of fluoroscopy exposures (19.95 vs 29.67; P<0.001), and was associated with faster learning curves. Complications and functional scores were statistically similar between groups but numerically favoured the virtual planning group.
Conclusion: Virtual planning improved implant selection consistency, short nail utilisation, and surgical efficiency. It demonstrated numerically superior clinical outcomes.
长股骨近端髓内钉是治疗转子下骨折的挑战。短指甲可能是一个合适的选择；然而，传统的术前计划在评估其适当性方面存在局限性。本研究探讨了计算机辅助虚拟规划是否可以提高种植体选择的一致性、短钉的利用率和手术结果。方法：本回顾性队列研究分析了2009年至2018年在中国一级创伤中心接受股骨近端髓内钉治疗的103例患者（虚拟计划57例，常规计划46例）。传统的计划依赖于影像学和外科医生的经验。虚拟规划使用三维计算机断层扫描重建来模拟骨折复位并确定最佳种植体尺寸。主要结果是计划和实际种植体尺寸的选择。次要结局包括手术参数、并发症、植入物相关不良事件和12个月时的功能评分。进行了稳健的多变量协方差分析和逻辑回归分析。结果：与常规规划相比，虚拟规划与实际短/长钉选择（kappa系数=0.95 vs 0.54）和种植体尺寸（类内相关系数：0.889-0.971 vs 0.786-0.870）的一致性更高，实际短钉利用率更高（75.4% vs 52.2%）。虚拟规划缩短了手术时间（90.21 vs 141.67分钟）。结论：虚拟规划提高了种植体选择的一致性、短钉的利用率和手术效率。它显示了数字上优越的临床结果。
期刊介绍：
The HKMJ is a Hong Kong-based, peer-reviewed, general medical journal which is circulated to 6000 readers, including all members of the HKMA and Fellows of the HKAM. The HKMJ publishes original research papers, review articles, medical practice papers, case reports, editorials, commentaries, book reviews, and letters to the Editor. Topics of interest include all subjects that relate to clinical practice and research in all branches of medicine. The HKMJ welcomes manuscripts from authors, but usually solicits reviews. Proposals for review papers can be sent to the Managing Editor directly. Please refer to the contact information of the Editorial Office.
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