计算机辅助设计-快速成型在股骨转子间骨折修复中的应用:与常规手术修复效果比较

Application of computer-aided design-rapid prototyping in intertrochanteric fracture:Compared to routine operation

背景：计算机辅助设计-快速成型技术的发展,实现了从二维图像到三维实物的飞跃,为临床医生对疾病的诊断、病变点的定位、手术方案的确定提供了重要的依据,使得手术的安全性和手术的质量有了明显的提高。目的：评估计算机辅助设计-快速成型技术应用于股骨转子间骨折手术治疗的临床疗效。方法：选择2008年解放军广州军区广州总医院骨科收治的股骨转子间骨折患者30例,年龄18-55岁,随机分成常规手术组及计算机辅助组,常规手术组仅行术前胫骨结节牵引,计算机辅助组行胫骨结节牵引后提取二维CT数据,计算机辅助设计股骨转子间骨折模型,并模拟骨折复位手术,逆向设计与股骨大转子相吻合的组件,计算机精确设计手术钉道。两组均采用动力髋螺钉内固定,均记录手术时间,术中出血量,术后随访1年并采用Harris评分标准对手术效果进行评估。结果与结论：快速成型建立股骨转子间骨折的1∶1实体模型及置钉导向模版,精确地指导手术快速精确实施。快速成型技术做好的模型应用于手术,提高了手术的安全性,与常规手术组比较缩短了手术时间,减少了手术出血量,术后复查X射线见骨折端复位良好,内固定位置良好,应用Harris髋关节评分患者恢复良好,无髋内翻畸形及患肢短缩畸形,显著提高了手术的有效性,均达到了术前的预期效果。相比传统手术存在精确性不足、创伤较大、术中医生和患者需要反复受到射线照射等缺点,计算机辅助骨科-快速成型技术应用于手术具有安全,准确等优点,术前采集图像可术中反复使用,并减少术中医患的放射性损伤。

BACKGROUND：Development of computer-aided design（CAD）-rapid prototyping implements planar image to three-dimensional solid digitization,thus,provides guidance for disease diagnosis,focus location,and operation project confirmation,which significantly enhance the security and quality of operation. OBJECTIVE：To evaluate the therapeutic effect of CAD-rapid prototyping on treating femoral intertrochanteric fracture. METHODS：A total of 30 cases of intertrochanteric fracture,aged 18-55 years,were selected from Department of Orthopaedics,General Hospital of Guangzhou Command.All cases were randomly divided into the routine operation and CAD groups.Traction on tibial tubercle was performed in the routine group;in the CAD group,exception of traction on tibial tubercle,CT data were extracted,intertrochanteric fracture mode was constructed by CAD,operation reposition on femoral intertrochanteric fracture was simulated,the module match with Greater trochanter of femur,as well as the screw patch was designed.Operation duration and bleeding amount were recorded in the operation.The therapeutic effect was evaluated by using Harris scores at 1 year follow-up. RESULTS AND CONCLUSION：Femoral intertrochanteric fracture 1：1 model and screw implanting platen could guide the operation accurately,which elevated operating security.Compared to the routine group,CAD decreased operation duration and bleeding amount,with excellent reposition.Harris scores for hip joint showed that the patients recovered well after operation.There was no deformity of coxa vara or shortened limb.All patients achieved the anticipation of clinic purpose.CAD-rapid prototyping overcome the disadvantages,such as inaccurately,great trauma,and repeated radiation exposure of routine operation,which is more safety to patients and doctors.