Digital orthopedic technology in the positioning of volar plate in distal radius fracture

doi:10.3969/j.issn.2095-4344.2014.04.020

Abstract

Abstract:

BACKGROUND: Volar locking plate is the dominant treatment of distal radial fractures, but it is difficult to judge the distance between the plate position and the carpal articular surface, thus leading to screw penetration of the articular surface. Arthroscopy or operative perspective has their pros and cons, there is no simple and effective method of positioning the plate.

OBJECTIVE: To find the optimal position of Volar LCP in distal radius fractures and explore the role of computer simulation in this treatment.

METHODS: The CT data of the wrists in 20 adult patients were collected to calculate 3D models of the radius by MIMICS software. 3D model of the LCP was calculated by UG in working station. The distance between the plate and the distal radius joint was measured by computer simulation, and the mean value was calculated. A total of 33 Patients with distal radial fractures were divided into two groups: conventional treatment group (regular X-ray and CT) and computer simulation group (preoperative plan based on the computer-measured data).

RESULTS AND CONCLUSION: The safe distance between the screw center and the articular facet was 11.13 mm in males and 10.97 in females. The number of radiation and operating time were shortened significantly in computer simulation group (P < 0.05). Experimental findings indicate that, computer simulation is a powerful tool to find the optimal position of volar LCP in the distal radius fractures. The time of the operation and X-ray fluoroscopy are also shortened significantly.

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

全文链接：

Key words: radius fracture, internal fixators, surgery, computer-assisted, computer

CLC Number:

R318

Chen Gang, Lian Kai, Cui Lu, Wu Nong-xin, Lu Xin-yan, Wang Bang-jun, Chen Feng-wen . Digital orthopedic technology in the positioning of volar plate in distal radius fracture[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(4): 607-612.

Figures/Tables 2

2.1 参与者数量分析纳入患者33例，分为2组，按意向性处理分析，全部进入结果分析。 2.2 两组患者基线资料分析见表1。 2.3 正常人群的桡骨模型中钢板边缘及远排螺钉中心孔距离桡骨远端边缘的距离通过建模模拟安置钢板并测量后分析得知，男性组中钢板远排螺孔中心同关节面边缘的垂直距离最大为11.75 mm，最小为10.72 mm，95%可信区间为(11.13± 0.65) mm；桡骨关节面距钢板边缘距离最大为6.35 mm，最小为5.41 mm，95%可信区间为 (5.73±0.65) mm。女性组中钢板远排螺孔中心同关节面边缘的垂直距离最大为11.50 mm，最小为10.73 mm，95%可信区间为(10.97±0.59) mm；桡骨关节面距钢板边缘距离最大为6.10 mm，最小为5.28 mm，95%可信区间为(5.56± 0.59) mm。男性女性组别之间差异无显著性意义（表2）。 2.4 两组患者手术中透视次数及操作时间常规规划组平均操作时间为74 min，计算机规划组平均操作时间为 60 min，方差齐性，P=0 < 0.05，两组之间差异有显著性意义；常规规划组治疗中透视次数平均为13.33次，计算机规划组为8.77次，方差齐性，P=0 < 0.05，两组之间差异有显著意义。由于本院手术室治疗中透视制度要求透视时医师包括手术及麻醉医师及护士均在隔离房门之外操作。故每次透视耗时为2-5 min不等。如透视次数较多，则手术时间相应延长。据上分析可知两组之间操作时间差异主要可能是因为透视时间的差异（表3）。 2.5 患者治疗后摄片及功能随访结果所有患者拔除引流管后均行早期功能练习。并在1周内摄片复查骨折对位线及掌侧钢板的位置，并检查腕关节主动被动活动时有无关节疼痛及摩擦异感。结果显示，两组患者治疗后复查X射线骨折对位线均理想。钢板远排螺钉位于软骨下骨，起到支持关节面的作用，并且X射线阅片未见螺钉穿出关节面(图4)。 2.6 并发症功能检查结果提示两组均未见腕关节摩擦感等异样感觉，未见明显活动障碍。全组未见治疗后感染病例，未见治疗术后再次手术调整内固定物病例，仅有1例患者出现治疗后正中神经牵拉轻度麻痹症状，1例患者出现桡神经浅支部分损伤症状，均保守对症治疗后好转。常规规划组病例中选用传统术前规划结合术中探查加C臂机X射线透视方法治疗后的骨折对位线及螺钉穿出现象同采用计算机模拟术前规划，根据术前规划模拟手术确定钢板位置及同关节边缘距离的计算机规划组相比并无明显差别。而计算机规划组的治疗操作时间较常规规划组显著减少，这就从理论上降低了感染及其他同治疗操作时间正相关的并发症发生，且计算机规划组治疗中透视次数较常规规划组的减少，不但减少了医护人员的放射暴露，同时也减少了病患的放射暴露。而后者在既往的医疗行为中往往被忽视，而且缺乏具体的保护措施。透视次数的减少是对患者健康的保护，同时也体现了现代个性化医疗中对患者的全面关怀。"

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