基于真实CT数据骨科虚拟手术计划在髋臼骨折手术中的运用

Virtual operation planning in orthopedic surgery for acetabular fractures based on real CT data

背景:骨科虚拟手术计划有助于提高外科医生的手术精确性。目的:探索计算机术前模拟手术技术在骨盆、髋臼骨折的治疗中的应用方法及临床价值。方法:对13例骨盆及髋臼骨折患者进行螺旋CT影像扫描,将其DICOM数据输入个人计算机中Mimics软件,使用分割方法,于内固定前建立计算机模拟手术过程。结果与结论:骨块分割出来和提取关节表面模型的平均时间为45min(30～70min),操作者可进行骨折复位与固定时间平均为28min(16～45min)。计划13例手术入路,最终12例完全采用,12例完全采用了模拟手术固定方法,1例部分采用了计划固定方法;螺钉数与术前计划一致的有10例患者,螺钉长度与术前计划一致的有8例,固定钢板与术前计划一致的11例。随访CT显示关节面解剖复位6例(46%),7例(54%)满意,没有螺钉穿入关节腔。说明通过计算机术前模拟手术,可以制定准确的手术方案,为指导实际手术提供数据支持。

BACKGROUND： Virtual operation planning can help surgeons to improve the accuracy of orthopedic operations. OBJECTIVE：To test the feasibility and clinical value of preoperative virtual surgical planning in pelvis and acetabular fractures using Mimics software based on an interactive virtual reality-style environment. METHODS： Thirteen patients with pelvis and acetabular fractures were scanned with spiral CT preoperatively. The real data from CT in DICOM format were transformed into Mimics software. With segmentation process, each fracture segment became a separate object. Bone fragments could be moved and rotated in all three planes and reduction was performed. Then we performed all the steps of the surgical procedure. RESULTS AND CONCLUSION： The median time needed to segment the osseous parts of an entire pelvis and to extract a surface model was 45 minutes （ranging 30 to 70 minutes）, and the median time for fracture reduction was 28 minutes （ranging 16 to 45 minutes）. The planned approach was followed in 12 of the 13 cases, the planned fixation was followed completely in 12 cases and partially in 1 cases. The screw count was identical to the planned operation in 10 cases, the screw length was identical in 8 cases, and fixation plate count was identical in 11 cases. Postoperative congruence of the acetabular joint surface as determined according to Matta in the follow-up CT was anatomic in 6 cases （46%） and satisfactory in 7 cases （54%）. There was no case with inadvertent penetration of the hip joint. Virtual operation planning in orthopedic surgery is helpful for enacting accurate operation program and providing data reference for actual operation, which brings significant value and new opportunities in clinical practice.