Digital internal fixation for proximal tibial fracture guides clinical restorative treatment

doi:10.3969/j.issn.2095-4344.2015.39.024

Abstract

Abstract:

BACKGROUND: On CT reconstruction of three-dimensional model, fracture virtual reduction and internal fixation cannot be achieved, so reasonable operation scheme cannot be formulated. It cannot fully meet the needs of clinical orthopedics physicians.
OBJECTIVE: To explore the methods to perform three-dimensional reconstruction, reduction on proximal tibial fracture and designing digital internal fixation using Mimics and Solidworks software, and to guide the operation and to observe the clinical efficacy.
METHODS: A total of 40 cases of proximal tibial fracture patients were enrolled and treated with high-speed CT scan. Three-dimensional reconstruction and reduction were performed in Mimics. The plates and screws were designed and selected in Solidworks. Virtual internal fixation on the reduced three-dimensional models was performed. This operation scheme was prepared and applied. Union of fracture and self-evaluation (MacNab standard) were observed after surgery.
RESULTS AND CONCLUSION: Three-dimensional reconstruction, reduction and accurate fixation of plates and screws were conducted in all bone fracture models. The clinical operation was smoothly going, completed successfully according to the digital scheme of the preoperative design. The curative effect is satisfied. A total of 40 patients were followed up for 12-24 months. The time of fracture union was 12-18 weeks, averagely 13.6 weeks. The time of complete weight loading was 15-17 weeks, averagely 15.8 weeks. In accordance with MacNab standard, there were excellent in 29 cases, good in 9 cases, average in 2 cases, poor in 0 case, with the excellent and good rate of 95%. Plate and screw specifications, screw length, diameter, position, and angle were consistent with preoperative data. These findings show that the digital scheme of internal fixation for proximal tibial fracture could be designed in Mimics and Solidworks with a personal computer. Our experience can provide a good reference for the practical operation

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

Key words: Tibial Fractures, Internal Fixators, Imaging, Three-Dimensional, Bone Nails

CLC Number:

R318

Chen Xuan-huang, Wu Xian-wei, Lin Hai-bin, Wu Chang-fu, Zheng Feng, Guo Qing-qing, Zhang Guo-dong. Digital internal fixation for proximal tibial fracture guides clinical restorative treatment[J]. Chinese Journal of Tissue Engineering Research, doi: 10.3969/j.issn.2095-4344.2015.39.024.

Figures/Tables 4

References

[1] 蔡伟斌,胡鸿璇,郭新辉,等.锁定加压钢板与解剖钢板置入内固定治疗复杂胫骨平台骨折[J].中国组织工程研究,2012,16(52): 9750-9755.
[2] 张国栋,陶圣祥,郑和平,等.基于三维重建技术的股骨远端数字钢板设计[J].实用骨科杂志,2010,16(1):35-38.
[3] Mc Broom S, Bruce D.The tibial plateau fracture.The Toronto experience 1968-1975.Clin Orthop. 1979;(138):94-104.
[4] Borrelli J Jr,Prickett W,Song E,et al. Extraosseous blood supply of the tibia and the effects of different plating techniques: a human cadaveric study. J Orthop Trauma. 2002;16(10):691-695.
[5] MacNab I. Negative disc exploration. An analysis of the causes of nerve-root involvement in sixty-eight patients. J Bone Joint Surg(Am). 1971;53(5):891-903.
[6] Gösling T, Klingler K, Geerling J, et al. Improved intra-operative reduction control using a three-dimensional mobile image intensifier--a proximal tibia cadaver study. Knee.2009;16(1):58-63.
[7] Papagelopoulos PJ, Partsinevelos AA, Themistocleous GS, et al. Complications after tibia plateau fracture surgery. Injury.2006;37(6):475-484.
[8] Taylor J, Langenbach A, Marcellin-Little DJ. Risk factors for fibular fracture after TPLO. Vet Surg. 2011;40(6): 687-693.
[9] Yu Z,Zheng L,Zhang Y,et al. Functional and radiological evaluations of high-energy tibial plateau fractures treated with double -buttress plate fixation. Eur J Med Res. 2009;14(5): 200-2005.
[10] Yu B,Han K,Zhan C,et al.Fibular head osteotomy: a new approach for the treatment of lateral or posterolateral tibial plateau fractures. Knee. 2010;17(5):313.
[11] Cimerman M, Kristan A. Preoperative planning in pelvic and acetabular surgery: The value of advanced computerised planning modules. Injury. 2007;38:442-449.
[12] 扈延龄,金丹,苏秀云,等.基于三维CT数据的髋臼骨折计算机辅助虚拟手术设计[J]. 中华创伤骨科杂志, 2008, 10(2): 137-137.
[13] Doornberg JN, Rademakers MV, van den Bekerom MP, et al.Two-dimensional and three-dimensional computed tomography for the classification and characterisation of tibial plateau fractures. Injury. 2011;42(12):1416-1425.
[14] Waschke A, Walter J, Duenisch P, et al. CT-navigation versus fluoroscopy-guided placement of pedicle screws at the thoracolumbar spine: single center experience of 4,500 screws. Eur Spine J. 2013;22(3):654-660.
[15] 田伟,郎昭,刘亚军,等.术中即时三维导航辅助下轴性旋转腰椎椎弓根螺钉置入的实验研究[J]. 中华外科杂志,2010,48(11): 838-841.
[16] Villard J, Ryang YM, Demetriades AK, et al. Radiation exposure to the surgeon and the patient during posterior lumbar spinal instrumentation: a prospective randomized comparison of navigated versus non-navigated freehand techniques. Spine (Phila Pa 1976). 2014;39(13): 1004-1009.
[17] Tormenti MJ, Kostov DB, Gardner PA, et al. Intraoperative computed tomography image-guided navigation for posterior thoracolumbar spinal instrumentation in spinal deformity surgery. Neurosurg Focus. 2010;28(3): E11.
[18] Lee MH, Lin MH, Weng HH, et al. Feasibility of Intra-operative Computed Tomography Navigation System for Pedicle Screw Insertion of the Thoraco-lumbar Spine. J Spinal Disord Tech. 2012.
[19] Hodges SD, Eck JC, Newton D. Analysis of CT-based navigation system for pedicle screw placement. Orthopedics. 2012;35(8):1221-1224.
[20] Tabaraee E, Gibson AG, Karahalios DG, et al. Intraoperative cone beam-computed tomography with navigation (O-ARM) versus conventional fluoroscopy (C-ARM): a cadaveric study comparing accuracy, efficiency, and safety for spinal instrumentation. Spine (Phila Pa 1976). 2013;38(22): 1953-1958.
[21] Oertel MF, Hobart J, Stein M, et al. Clinical and methodological precision of spinal navigation assisted by 3D intraoperative O-arm radiographic imaging. J Neurosurg Spine. 2011;14(4):532-536.
[22] Silbermann J, Riese F, Allam Y, et al. Computer tomography assessment of pedicle screw placement in lumbar and sacral spine: comparison between free-hand and O-arm based navigation techniques. Eur Spine J. 2011;20(6):875-881.
[23] Kantelhardt SR, Martinez R, Baerwinkel S, et al. Perioperative course and accuracy of screw positioning in conventional, open robotic-guided and percutaneous robotic-guided, pedicle screw placement. Eur Spine J. 2011;20(6):860-868.
[24] Bourgeois AC, Faulkner AR, Bradley YC, et al. Improved Accuracy of Minimally Invasive Transpedicular Screw Placement in the Lumbar Spine with Three-dimensional Stereotactic Image Guidance: A Comparative Meta-analysis. J Spinal Disord Tech. 2014.
[25] Lu S, Xu YQ, Zhang YZ, et al. A novel computer-assisted drill guide template for placement of C2 laminar screws. Eur Spine J. 2009;18(9):1379-1385.
[26] Merc M, Drstvensek I, Vogrin M, et al. A multi-level rapid prototyping drill guide template reduces the perforation risk of pedicle screw placement in the lumbar and sacral spine. Arch Orthop Trauma Surg. 2013;133(7):893-899.
[27] Ma T, Xu YQ, Cheng YB, et al. A novel computer-assisted drill guide template for thoracic pedicle screw placement: a cadaveric study. Arch Orthop Trauma Surg. 2012;132(1):65-72.
[28] Hu YL, Ye FG, Ji AY, et al. Three-dimensional computed tomography imaging increases the reliability of classification systems for tibial plateau fractures. Injury. 2009;40(12): 1282-1285.
[29] Hu Y,Li H,Qiao G,et al.Computer-assisted virtual surgical procedure for acetabular fractures based on real CT data. Injury.2011;42(10):1121-1124.
[30] Messmer P,Brig G,Suhm N,et al.Three-dimensional fracture simulation for preoperative planning and education.Eur J Trauma. 2001;27:171-177.
[31] Osti M,Philipp H,Meusburger B,et al.Analysis of failure following anterior screw fixation of Type II odontoid fractures in geriatric patients. Eur Spine J. 2011;20(11):1915-1920.
[32] Osti M,Philipp H,Meusburger B,et al.Analysis of failure following anterior screw fixation of Type II odontoid fractures in geriatric patients. Eur Spine J. 2011;20(11):1915-1920.
[33] Chen C,Ruan D,Wu C,et al.CT morphometric analysis to determine the anatomical basis for the use of transpedicular screws during reconstruction and fixations of anterior cervical vertebrae. PLoS One. 2013;8(12):e81159．
[34] Khoury A,Liebergall M,Weil Y,et al. Computerized fluoroscopic-based navigation-assisted intramedullary nailing. Am J Orthop. 2007;36(11):582-585.
[35] 张国栋,林海滨,陈宣煌,等.基于多平面三维测量的髋臼骨折数字化内固定置入方案[J].中华临床医师杂志:电子版,2012,6(8): 2010-2015.
[36] 陈宣煌,张国栋,吴长福,等.数字化颈前路螺钉内固定方案设计：Ⅱ型齿状突骨折的临床应用[J].中国组织工程研究,2013,17(26): 4926-4933.
[37] 陈宣煌,林海滨,张国栋,等.腰椎后路数字化内固定手术方案及临床应用[J].中华临床医师杂志:电子版,2012,6(17):5249-5251.
[38] 陈宣煌,林海滨,张国栋,等.枕颈融合内固定治疗C1 Jefferson骨折的数字化设计及意义.中华临床医师杂志:电子版,2013,7(9): 4110-4112.
[39] 陈宣煌,张国栋,吴长福.C1侧块骨折Magerl技术内固定的数字化模拟及应用[J].临床骨科杂志,2013,16(6):712-715.
[40] Blemker SS, Asakawa DS,Gold GE,et al.Image-based musculoskeletal modeling:applications, advances, and future opportunities.J Magn Reson Imaging. 2007;25(2):441-451.
[41] Aurouer N, Obeid I, Gille O, et al. Computerized preoperative planning for correction of sagittal deformity of the spine. Surg Radiol Anat. 2009;31:781-792.
[42] Klein S, Whyne CM, Rush R, et al.CT-based patient-specific simulation software for pedicle screw insertion. J Spinal Disord Tech. 2009;22(7):502-506.