计算机模拟在儿童创伤性肘内翻畸形治疗中的应用

Application of computer simulation for traumatic cubitus varus deformity in children

目的观察基于三维CT重建的计算机模拟在儿童创伤性肘内翻畸形的术前手术设计以及手术治疗中的使用效果。方法从2012年1月至2015年1月,西安交通大学附属红会医院儿骨科收治26例创伤性肘内翻畸形患儿,其中男17例,女9例;左侧15例,右侧11例。年龄5岁3个月至13岁7个月,平均8岁4个月。术前患侧肘关节内翻角为12°~37°,平均21°。正常侧提携角为5°~20°,平均14°。通过三维CT检查患侧肘关节,将原始CT数据导入Mimics10.01软件,运用专用工具进行术前模拟肱骨髁上外侧楔形截骨,观察模拟手术的效果。术中采用肘关节造影清楚显示肘关节的关节面,利用克氏针定位确定截骨平面和截骨角度,截骨后交叉克氏针钢丝张力带固定。结果所有儿童的肘内翻畸形获得了良好的矫正。26例均获得随访14~60个月,平均34个月。术后疗效依据Flynn肘关节功能评分标准:优18例,良4例,可4例,优良率84.6%。最终随访时患侧提携角为4°~17°,平均12°。结论基于三维CT重建的计算机模拟可使术者了解合适的肱骨髁上截骨位置、截骨角度,可以指导实际的手术操作,能获得更好的术后矫形效果。术中肘关节造影有利于确定截骨的平面,有辅助手术操作的作用。

Objective To explore the efficacy of three-dimensional (3D) computed tomography (CT)-based simulated reconstruction for traumatic cubitus varus deformity in children including preoperative designs and surgical procedures. MethodsFrom January 2012 to January 2015, 26 cases with traumatic cubitus varus were analyzed.There were 17 boys and 9 girls with an average age of 100 months.The involved side was left (n=15) and right (n=11). The average varus angle was 21 (12-37) degrees and the average carrying angle of contralateral side 14 (5-20) degrees.The original three-dimensional CT data were transferred into Mimics 10.01 software.Special tools were used for simulating supracondylar lateral wedge humeral osteotomy.Intraoperative application of elbow arthrography could distinctly visualize the articular surface of elbow joint.Kirschner wire was employed for determining the plane and angle of osteotomy.And osteotomy site was fixed with crossing Kirschner wires and steel wire tension band. ResultsThe corrections of varus deformities were excellent.The average follow-up period was 34 (14-60) months.According to the Flynn criteria for evaluating the postoperative efficacy of elbow joint function, the outcomes were excellent (n=18), good (n=4) and fair (n=4). The excellent rate was 84.6%.At the final follow-up, the average ipsilateral carrying angle was 12 (4-17) degrees. Conclusions3D-CT reconstruction and simulation enable a proper understanding of humeral osteotomy position and osteotomy angle.It is helpful for guiding actual handling and achieving optimal outcomes.Intraoperative elbow arthrography may determine the level of elbow joint osteotomy and assist operations.