中国组织工程研究

中国组织工程研究 ›› 2016, Vol. 20 ›› Issue (13): 1918-1924.doi: 10.3969/j.issn.2095-4344.2016.13.013

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

数字骨科技术在股骨转子间骨折植入物修复前的规划作用

缪  锌，邓高荣，凌  强   

  1. 南昌大学第四附属医院骨科，江西省南昌市  330000
  • 收稿日期:2016-02-24 出版日期:2016-03-25 发布日期:2016-03-25
  • 通讯作者: 凌强，副教授，硕士生导师，南昌大学第四附属医院骨科，江西省南昌市 330000
  • 作者简介:缪锌，男，1988年生，湖南省长沙市人，汉族，南昌大学医学院在读硕士，医师，主要从事创伤及关节外科研究。
  • 基金资助:
    江西省科技支撑计划项目(20112BBG70072)

Digital orthopedics technology in preoperative planning of implant fixation for intertrochanteric fracture

Miao Xin, Deng Gao-rong, Ling Qiang   

  1. Department of Orthopedics, Fourth Affiliated Hospital of Nanchang University, Nanchang 330000, Jiangxi Province, China
  • Received:2016-02-24 Online:2016-03-25 Published:2016-03-25
  • Contact: Ling Qiang, Associate professor, Master’s supervisor, Department of Orthopedics, Fourth Affiliated Hospital of Nanchang University, Nanchang 330000, Jiangxi Province, China
  • About author:Miao Xin, Studying for master’s degree, Physician, Department of Orthopedics, Fourth Affiliated Hospital of Nanchang University, Nanchang 330000, Jiangxi Province, China
  • Supported by:

    the Jiangxi Science and Technology Support Program, No. 20112BBG70072

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被引次数

1

摘要：

文章快速阅读：

 

文题释义：

股骨转子间骨折三维重建模型：通过收集患者股骨近端CT扫描断层数据，利用通过mimics多种分割工具可以将所有骨折块一一分割，利用三维重建功能，能将所有骨折块空间立体位置逐一展现，并且可以将骨折块标记以不同的颜色加以区分。重建后的模型不但可以透明化、整体平移、旋转任意角度，而且还可以将单个独立的骨折块透视化、隐藏、平移及旋转，模拟骨折的复位。
股骨近端锁定加压钢板：其具有锁定和加压双重功能，能够降低患者治疗后并发症发生率。该系统锁定螺钉为空心螺钉，先置入克氏针透视定位，再沿克氏针拧入螺钉，提高螺钉拧入速度及准确性，如何准确置入定位克氏针，成为修复成功的关键。

 

背景：股骨转子间骨折一般以手术治疗为主，随着对股骨近端生物力学研究的深入，近年来出现了股骨近端锁定加压钢板，其并非坚强固定，可以减少局部应力遮挡，维持系统的最佳稳定性，但却经常出现因钉板选择不当致使骨折固定失效等问题。
目的：探讨数字骨科技术在股骨转子间骨折股骨近端锁定加压钢板置入内固定修复前的规划作用。
方法：选取股骨转子间骨折行股骨上段CT断层扫描患者40例，分为两组，常规组在常规X射线及CT阅片后行股骨近端锁定加压钢板置入内固定治疗；计算机规划组修复前根据Mimics软件建立骨折模型、分割骨折碎块、模拟手术复位并运用3-matic重建锁定加压钢板及螺钉，在Mimics装配锁定钢板，取得最佳钢板安放位置、最佳螺钉置入角度、螺钉长度后行股骨近端锁定加压钢板置入内固定治疗。对比两组患者的透视次数、手术操作时间、失血量及骨折愈合时间。

结果与结论：重建得到股骨近端三维模型，测量得到一系列解剖数据，得出每例患者锁定钢板的最佳安放位置，预测螺钉长度，可以实现修复术前规划。所有患者均获得随访，随访时间6-20个月。计算机规划组患者修复过程中透视次数、手术操作时间及失血量显著少于常规组(P < 0.05)，而骨折愈合时间与常规组差异无显著性意义(P > 0.05)。提示将数字骨科技术应用于股骨转子间骨折，可以在修复术前模拟锁定钢板的安放位置，提前确定螺钉置入角度及螺钉长度，减少老年股骨转子间骨折患者的透视次数、手术操作时间、失血量及螺钉位置失准发生率。 

ORCID: 0000-0002-7584-6962 (凌强)

关键词: 骨科植入物, 数字化骨科, 股骨转子间骨折, 三维重建, 术前模拟规划

Abstract:

BACKGROUND: Intertrochanteric fractures can be generally treated by surgical treatment. Along with deep research on the biomechanics of the proximal femur, proximal femoral locking compression plate appears recently. The locking plate fixation is not strong, can reduce the local stress shielding, and maintain optimal system stability, but fracture fixation failure often occurs due to the inappropriate choice of nail plate. 
OBJECTIVE: To evaluate the value of digital orthopedics technology in preoperative planning in locking plate fixation for intertrochanteric fracture.
METHODS: Forty intertrochanteric fracture patients receiving CT tomography femur upper segment were selected and divided into two groups. In the conventional group, after reading X-ray films and CT images, patients received locking plate fixation. In the computer planning group, before repair, fracture model was established using Mimics software to segment fracture fragments, simulate operation reset and 3-matic software was used to reconstruct locking plate and screws. Locking plate was assembled with Mimics to obtain the best plate position, best screw angle and screw length. Proximal femoral locking compression plate fixation was performed. Fluoroscopy times, operation time, blood loss and fracture healing time were compared in both groups.
RESULTS AND CONCLUSION: Three-dimensional models of proximal femur were reconstructed, and a series of data were obtained. The optimal position of each plate was obtained from each patient. The screw length was predicted, so preoperative operation planning was realized. All patients were followed up for 6-20 months. Fluoroscopy times, operation time, and blood loss were significantly less in the computer planning group than in the conventional group (P < 0.05). No significant difference in fracture healing time was detected between the two groups (P > 0.05). These findings suggest that digital orthopedics technology used in intertrochanteric fracture can simulate the locking plate position, determine the screw placement angle and length of the screw in advance, and reduce fluoroscopy times, operation time, blood loss and screw position misalignment.