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

doi:10.3969/j.issn.2095-4344.2016.13.013

Abstract

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.

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

Miao Xin, Deng Gao-rong, Ling Qiang . Digital orthopedics technology in preoperative planning of implant fixation for intertrochanteric fracture[J]. Chinese Journal of Tissue Engineering Research, 2016, 20(13): 1918-1924.

Figures/Tables 3

References

[1] 胥少汀.实用骨科学[M].北京:人民军医出版社, 2012: 947-948.

[2] Pioli G, Barone A, Giusti A, et al. Predictors of mortality after hip fracture: results from 1-year follow-up. Aging Clin Exp Res. 2006;18(5): 381-738.

[3] 张魁忠,周荣平,徐聪,等.股骨近端锁定钢板治疗股骨粗隆间骨折的疗效评估[J].南方医科大学学报, 2009, 29(12): 2561-2562.

[4] 刘晓辉,张国川.锁定加压钢板生物力学原理及置入后的失败分析[J].中国组织工程研究与临床康复, 2011,15(4): 717-720.

[5] 李亚光, 陈向军. 数字骨科临床应用研究进展[J]. 内蒙古医学杂志, 2012,44(5): 579-582.

[6] 王剑,云文科.数字骨科在骨科临床的研究进展[J].中外医疗,2014,33(26): 197-198.

[7] 危杰.股骨转子间骨折[J]. 中华创伤骨科杂志,2004,6(5): 79-82.

[8] Evans EM. The treatment of trochanteric fractures of the femur. J Bone Joint Surg Br. 1949; 31B(2): 190-203.

[9] 付淼,李莉,何叶松. Mimics与医学图像三维重建[J].中国现代医学杂志,2010,(19): 3030-3031.

[10] 刘成芬.股骨粗隆手术术后护理[J]. 吉林医学, 2014, 35(29):6629.

[11] Jain R, Basinski A, Kreder HJ. Nonoperative treatment of hip fractures. Int Orthop. 2003;27(1): 11-7.

[12] 阮建伟,宫小康,孔劲松. 股骨近端锁定钢板内固定治疗股骨粗隆间骨折[J]. 中国骨与关节损伤杂志, 2013, 28(4):348-349.

[13] 隋广维. 锁定式钢板治疗股骨粗隆间骨折20例分析[J]. 当代医学, 2010, (1): 87-88.

[14] 梅雷,卞正金,陈贞庚,等. 老年股骨粗隆间骨折手术内固定的选择[J]. 中国骨与关节损伤杂志, 2008, 23(12): 1017-1018.

[15] 刘世峰,崔文波,廖志峰,等.股骨近端锁定解剖加压钢板治疗老年股骨粗隆间骨折[J]. 中国继续医学教育, 2013, (4): 4-6.

[16] 张柏林.股骨粗隆间骨折采用股骨近端锁定加压钢板治疗的临床应用分析[J].中国继续医学教育, 2014, 6(6): 39-40.

[17] 牛庆礼,孙辉,杨树彬,等.锁定加压钢板治疗四肢骨折术后失败原因探讨[J].中国骨与关节损伤杂志, 2009,24(9): 835-836.

[18] 彭朝华,杨彬,邹秋富,等.微创锁定加压钢板固定术中失误及术后早期并发症分析[J].四川医学, 2012, 33(6): 965-967.

[19] 张明辉,李国军,宋文超,等.多排CT三维重建在股骨粗隆间骨折治疗中的临床应用[J].中国骨与关节损伤杂志, 2014,29(2): 124-125.

[20] 张野.多排螺旋CT后处理技术在骨关节创伤诊断中的应用研究[J]. 中国现代药物应用, 2015, 9(1): 33-34.

[21] 曹振华, 银和平, 李树文. 股骨颈骨折空心钉内固定数字化模板的建立[J]. 中国组织工程研究, 2014, 18(31): 5017-5023.

[22] 陆建华,王志刚,黄莉,等.基于健侧三维数字解剖的桡骨头假体逆向工程研究[J].中国临床解剖学杂志, 2013, 31(4): 407-410.

[23] 陈刚, 廉凯,王邦军,等.计算机辅助技术联合2.4mm钢板系统在治疗桡骨远端C型骨折中的应用[J].广东医学, 2014,35(8): 1213-1216.

[24] 陈刚,吴农欣,廉凯,等.利用数字骨科技术进行术前规划对儿童Ⅱ型肱骨髁上骨折复位及进针顺序的影响[J]. 中国矫形外科杂志, 2014, 22(8): 760-762.

[25] 陈刚,吴农欣,崔露,等. 数字骨科技术结合张力带钢丝在尺骨鹰嘴ⅡB型骨折中的应用[J]. 实用骨科杂志, 2014, 20(2): 106-110.

[26] 陆建华,倪慧玉,王志刚,等.数字化定制桡骨小头假体并术前三维虚拟置换验证研究[J].中国修复重建外科杂志, 2013,27(9): 1065-1069.

[27] 杨晶,程奎,倪鹏辉,等.数字化快速成形技术在骨折畸形愈合个体化治疗的应用研究[J]. 中国骨与关节损伤杂志, 2015, 30(7): 727-729.

[28] 赖震,刘志祥,张兆飞,等. 三维重建技术在桡骨远端不稳定性骨折治疗中的应用[J]. 中国骨科临床与基础研究杂志, 2015, 7(2): 69-73.

[29] 彭鳒侨,张占磊,钟世镇,等.基于全膝关节置换的三维术前规划实践[J].中国数字医学, 2013,(12): 45-49.

[30] 凌遵龙,周友龙,沈龙山,等.计算机辅助人工髋关节置换术前规划系统及应用[J].中国现代医生,2011, 49(16): 119-120.

[31] 王小平,韦展图,黄俭,等.虚拟三维重建术前规划技术在Pilon骨折的应用研究[J].中国修复重建外科杂志, 2016, (1): 44-49.

[32] 王光达,张祚福,齐晓军,等.膝关节三维有限元模型的建立及生物力学分析[J]. 中国组织工程研究与临床康复, 2010, 14(52): 9702-9705.

[33] Park JC, Shin HS, Cha JY, et al. A three-dimensional finite element analysis of the relationship between masticatory performance and skeletal malocclusion. J Periodontal Implant Sci. 2015;45(1): 8-13.

[34] Yang M, Li C, Li Y, et al. Application of 3D Rapid Prototyping Technology in Posterior Corrective Surgery for Lenke 1 Adolescent Idiopathic Scoliosis Patients. Medicine(Baltimore). 2015; 94(8): 582.

[35] 张弛. 3D打印:产品制造的新革命[J].设计, 2011, (11): 46-49.

[36] 王富友,任翔,杨柳. 3-D打印技术在关节外科的应用[J]. 中国修复重建外科杂志, 2014, 28(3): 272-275.

[37] Deng A, Xiong R, He W, et al. [Postoperative rehabilitation strategy for acetabular fracture: application of 3D printing technique]. Nan Fang Yi Ke Da Xue Xue Bao. 2014;34(4): 591-593.

[38] Wu AM, Shao ZX, Wang JS, et al. The accuracy of a method for printing three-dimensional spinal models. PLoS One. 2015;10(4): e0124291.

[39] Zeng C, Xiao J, Wu Z, et al. Evaluation of three-dimensional printing for internal fixation of unstable pelvic fracture from minimal invasive para-rectus abdominis approach: a preliminary report. Int J Clin Exp Med. 2015;8(8): 13039-13044.

[40] Li XS, Wu ZH, Xia H, et al. The development and evaluation of individualized templates to assist transoral C2 articular mass or transpedicular screw placement in TARP-IV procedures: adult cadaver specimen study. Clinics (Sao Paulo). 2014;69(11): 750-757.

[41] 尤微,王大平,刘黎军,等.三维数字规划在肱骨近端骨折手术治疗中的应用研究[J]. 中华临床医师杂志(电子版), 2014,8(7): 1243-1247.