三维数字规划在肱骨近端骨折手术治疗中的应用研究

The application of digital orthopedic 3D visualization technology in preoperative planning of the proximal humeral comminuted fracture

目的探讨三维数字手术规划在肱骨近端骨折治疗中的应用。方法选择2011年9月至2012年8月间我院收治的临床肱骨近端骨折连续病例30例（研究组15例,对照组15例）,研究组病例的CT影像数据导入Mimics 10.01软件,三维重建肱骨近端骨折数字模型,对模型进行分型、数据测量及分析、分割骨折碎片、初步计算机模拟手术复位效果、立体显示。对两组在手术时间、术中出血量、术中透视次数、骨折愈合时间、Constant评分等方面进行对比。结果重建所得的肱骨近端骨折三维数字模型,可任意角度展现及观察骨折移位的方向、程度等特点,实现了术前手术规划设计、手术效果模拟及数据测量。本组30例均获随访,随访时间5-18个月。研究组的手术时间、术中出血量、术中透视次数明显低于对照组,而Constant评分高于对照组（P〈0.05）,两组骨折愈合时间无明显差异（P〉0.05）。结论三维数字技术重建的肱骨近端骨折模型可清晰展现骨折情况,并助于明确分型,有利于术前手术技术的设计,亦利于患方及手术团队了解病情,有助于提高手术效果、减少术中损伤、降低医患纠纷风险。

Objective To evaluate the value of digital orthopedic 3D visualization technology with Mimics software in classification and the preoperative plan of patients with proximal humeral comminuted fracture. Methods 30 proximal humeral fracture patients admitted from September 2011 to August 2012 were selected. The CT scanning image data of research group（15 cases） were imported into Mimics 10.01 software, exported to 3D reconstruction visual model, and classified. The three dimensional models were measured and simulated the operation progress with the computer. The other 15 cases（control group） were treated without computer simulation. Two groups were compared for their duration of operation, amount of bleeding, amount of intraoperative fluoroscopy, fracture healing time and Constant scores. Results The reconstruction of proximal humeral fractures with 3D visual model can accurately reflect fracture characteristics, fracture displacement direction and degree, and can be rotated to observation; preliminary realized the preoperative operation design, operation simulation and 3D data measurement before the operation. All 15 cases were followed up for 5-18 months. The duration of operation, amount of bleeding and amount of intraoperative fluoroscopy of research group were lower than control group, and Constant scores were higher than control group（P〈0.05）. There was no significant difference between two groups in fracture healing time（P〉0.05）. Conclusions The reconstructed three dimensional model of proximal humeral fractures with Mimics software can be clearly show the fracture situations and identify the fracture typing, that can provide the basis for preoperative design, simulation of reposition, selection of inside plant and measurements of 3D data. It is not only conducive to developing patients and operation teams to understand the fracture, but also can help to improve the effect of surgery, reduce the risk of intraoperative injury and reduce medical disputes.