中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (18): 2842-2847.doi: 10.12307/2023.217

• 数字化骨科 digital orthopedics • 上一篇    下一篇

基于三维骨折地图技术的跟骨骨折线分布研究

蒋代翔1,2,鲁  辉1,2,马  玲1,章  花1,刘定玺3,胜照友3,吴启梅4,刘  融1,2,5   

  1. 1武汉科技大学医学院,湖北省武汉市   430080;武汉科技大学附属普仁医院,2创新与转化研究所,5骨科,湖北省武汉市   430081;3武汉科技大学机械工程学院,湖北省武汉市   430080;4武汉刘三屋中医骨伤医院,湖北省武汉市   431400
  • 收稿日期:2022-01-19 接受日期:2022-02-28 出版日期:2023-06-28 发布日期:2022-09-17
  • 通讯作者: 刘融,博士,副教授,副主任医师,硕士生导师,武汉科技大学附属普仁医院骨科,湖北省武汉市 430081 吴启梅,硕士,副主任医师,武汉刘三屋中医骨伤医院,湖北省武汉市 431400
  • 作者简介:蒋代翔,男,1997年生,湖北省恩施市人,汉族,武汉科技大学在读硕士,主要从事数字骨科方面的研究。
  • 基金资助:
    湖北省自然科学基金委员会一般面上项目(2020CFB548),项目负责人:刘融;2021年度职业危害识别与控制湖北省重点实验开放基金项目(OHIC2021G06),项目负责人:刘融;武汉市卫生健康委医学科研项目(WZ20C29),项目负责人:刘融;武汉科技大学2021研究生创新创业基金项目(JCX2021116),项目负责人:鲁辉

Study on the distribution of calcaneal fracture line based on three-dimensional fracture map technology

Jiang Daixiang1, 2, Lu Hui1, 2, Ma Ling1, Zhang Hua1, Liu Dingxi3, Sheng Zhaoyou3, Wu Qimei4, Liu Rong1, 2, 5   

  1. 1School of Medicine, Wuhan University of Science and Technology, Wuhan 430080, Hubei Province, China; 2Institute of Innovation and Transformation, 5Department of Orthopedics, Puren Hospital Affiliated to Wuhan University of Science and Technology, Wuhan 430081, Hubei Province, China; 3School of Mechanical Engineering, Wuhan University of Science and Technology, Wuhan 430080, Hubei Province, China; 4Wuhan Liu Sanwu Traditional Chinese Medicine Orthopaedic Hospital, Wuhan 431400, Hubei Province, China
  • Received:2022-01-19 Accepted:2022-02-28 Online:2023-06-28 Published:2022-09-17
  • Contact: Liu Rong, MD, Associate professor, Associate chief physician, Master’s supervisor, School of Medicine, Wuhan University of Science and Technology, Wuhan 430080, Hubei Province, China; Institute of Innovation and Transformation, and Department of Orthopedics, Puren Hospital Affiliated to Wuhan University of Science and Technology, Wuhan 430081, Hubei Province, China Wu Qimei, Master, Associate chief physician, Wuhan Liu Sanwu Traditional Chinese Medicine Orthopaedic Hospital, Wuhan 431400, Hubei Province, China
  • About author:Jiang Daixiang, Master candidate, School of Medicine, Wuhan University of Science and Technology, Wuhan 430080, Hubei Province, China; Institute of Innovation and Transformation, Puren Hospital Affiliated to Wuhan University of Science and Technology, Wuhan 430081, Hubei Province, China
  • Supported by:
    General Program of Natural Science Foundation of Hubei Province, No. 2020CFB548 (to LR); 2021 Hubei Provincial Key Experiment Open Fund Project for Occupational Hazard Identification and Control, No. OHIC2021G06 (to LR); Wuhan Municipal Health and Wellness Commission Medical Research Project, No. WZ20C29 (to LR); 2021 Graduate Innovation and Entrepreneurship Fund Project of Wuhan University of Science and Technology, No. JCX2021116 (to LH)

摘要:

文题释义:
跟骨骨折:跟骨是人体重要的承重骨,形状不规则,内部主要由松质骨构成,常因高处坠落等暴力损伤而致骨折,其骨折发生率占全身骨折的2%,是最常发生骨折的附骨;此外,因骨折特征及周围软组织情况复杂,治疗难度较大且致残率较高。
骨折地图:又称“骨折线分布地图”,由Armitage等于2009年首次提出,通过多个骨折三维CT影像或三维重建模型,按特定解剖标志对齐到标准模板上,绘制骨折线并重叠形成“骨折线图”,随后以此发展出的“骨折热图”,这两种图像均属于骨折地图的研究范围。

背景:跟骨骨折在其解剖、生物力学、损伤机制等方面复杂性极高,治疗难度大。现有的骨折分类系统多样,临床选择尚不统一。近年来骨折地图绘制技术愈发完善,临床研究逐渐增多,为全身各部位骨折的骨折特征及损伤机制提供了新的研究思路。
目的:绘制跟骨骨折线图并转化为热图,分析跟骨骨折特征。
方法:回顾性研究68例(74足)跟骨骨折患者的病例资料。选取一位 34 岁健康男性(右侧)跟骨CT扫描数据,进行三维重建,作为骨折线绘制模板。将68例患者足踝CT扫描数据导入Mimics 20.0软件,重建三维骨折模型,再将骨折模型导入3-matic 12.0软件,模拟骨折复位并与标准模板拟合,在标准模板上临摹骨折线,创建骨折线图并转化为热图,分析骨折特征。
结果与结论:①跟骨骨折患者年龄大多分布于44-55岁,其中男性患者占85.3%,女性病例占14.7%;②跟骨骨折地图明显可见3条弧形带状高发区,A带:外侧壁环形高发区;B带:包含整个Gissane角并向外侧结节与底部交接处走行;C带:从后距关节面中间向后内侧走行,在内侧壁靠结节部向前部延伸;③结果表明,骨折地图能直观展现跟骨骨折特征,在跟骨的进一步分型、内固定设计、置钉策略、有限元分析的有效性验证等方面可以提供参考。

https://orcid.org/0000-0002-4965-7340 (蒋代翔);https://orcid.org/0000-0002-0575-3293 (刘融)

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程

关键词: 跟骨骨折, 骨折地图, 骨折热图, 骨折线, 三维重建

Abstract: BACKGROUND: Calcaneal fractures are extremely complex in terms of anatomy, biomechanics, and injury mechanisms, and are difficult to treat. The existing fracture classification systems are diverse, and the clinical selection is not uniform. In recent years, fracture mapping technology has become more and more perfect, and clinical research has gradually increased, providing new research ideas for fracture characteristics and injury mechanisms of fractures in various parts of the body.  
OBJECTIVE: To draw a calcaneal fracture line map and convert it into a heat map to analyze the characteristics of calcaneal fractures.
METHODS: The case data of 68 patients (74 feet) with calcaneal fractures were retrospectively studied. The CT scan data of the right calcaneus of a 34-year-old healthy male were selected for three-dimensional reconstruction and used as a template for drawing fracture lines. CT scan data of foot and ankle of 68 patients were imported into Mimics 20.0 software to reconstruct a three-dimensional fracture model. The fracture model was imported into 3-matic 12.0 software to simulate fracture reduction and to fit with the standard template. The fracture line was traced on the standard template. A fracture line map was created and converted into a heat map to analyze the fracture characteristics.  
RESULTS AND CONCLUSION: (1) Most of the patients with calcaneal fractures were 44-55 years old, of which 85.3% were male and 14.7% were female. (2) Three arc-shaped high-incidence areas were clearly visible on the map of calcaneal fractures. A belt: the annular high-incidence area of the lateral wall; B belt: covering the entire angle of Gissane and running towards the junction of the lateral tubercle and the bottom; C belt: from the middle of the posterior talar articular surface runs posteriorly and medially, and extends anteriorly by the tubercle in the medial wall. (3) The results show that the fracture map can directly display the characteristics of calcaneal fractures, and can provide references for further classification of calcaneus, internal fixation design, nail placement strategy, and finite element analysis validation.

Key words: calcaneal fracture, fracture map, fracture heat map, fracture line, three-dimensional reconstruction

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