术前计算机虚拟手术设计在肱骨近端骨折手术治疗中的应用

Application of computer-assisted preoperative planning in surgical treatment for proximal humeral fractures

目的探讨术前计算机虚拟手术设计在肱骨近端骨折手术治疗中的应用价值。方法将自2011-06—2013-07诊治的46例肱骨近端骨折术前CT扫描数据导入至Superimage软件,完成三维重建和骨折块间的分割后,进行计算机虚拟手术复位及内固定操作,以制定出精确的术前手术计划。46例均行切开复位钢板内固定治疗。结果对46例患者均能利用Superimage软件进行三维重建及智能分割,判断骨折断端形态及骨折线走行方向,实现骨折的虚拟复位及内固定操作。本组平均手术时间85.6 min,术中平均透视次数7.3次,术中平均出血量98.3 ml,切口均获一期愈合。X线摄片提示肱骨颈干角复位符合率为93.5%,钢板高度位置符合率为91.3%,前后位置符合率为95.7%,钢板轴线符合率为93.5%,肱骨头内下方均获得重建,并有内侧支撑螺钉固定。患者术后获得6~24个月,平均13个月的随访。骨折愈合时间平均为12.3周（10~16周）。根据Cruess标准,1例发生二期肱骨头缺血性坏死。末次随访时Constant-Murley评分平均为83.9分。结论利用Superimage软件对肱骨近端骨折进行术前计算机虚拟手术设计,可为手术医生在骨折复位方法、内固定物的种类及放置位置的选择等提供精确指导,从而获得良好的疗效。

Objective To explore application value of computer-assisted preoperative planning in surgical treatment for proximal humeral fractures. Methods Forty six patients with proximal humeral fracture admitted from Jun. 2011 to Jul. 2013 were included. After Dicom data of CT for all proximal humeral fractures were put into Superimage software for 3D reconstruction and intelligent segmentation, computer-assisted virtual surgical reduction and internal fixation were performed to carry out precise preoperative planning. All patients were treated with open reduction and internal fixation. Surgical time,blood loss and times of fluoroscopy were recorded during operations, quality of reduction and internal fixation for fractures were evaluated after operations, function of shoulder joint and complications of surgery were assessed in follow-up period.Results Three dimensional reconstruction and intelligent segmentation for all fractures were accomplished by Superimage software, which shape and orientation of fracture site were clearly obtained via arbitrarily rotating, moving and hiding bone fragments, as well as virtual surgical reduction and internal fixation. The average operation time was 85.6 min, the average blood loss was 98.3 ml and the average times of fluoroscopy were 7.3 during surgery. Postoperative X ray showed coincidence rate was 93.5% in fractures reduction, 91.3% in plate＇s height, 95.7% in anteroposterior position of plates and 93.5% in plate＇s axes, and medial columns of humeral heads were all obtained good reconstructing with medial screws supporting. All patients were followed up from 6 to 24 months with average 13 months and fractures were achieved healing in 12.3 weeks averagely（10-16 weeks）. There was 1 case with stage 2 avascular necrosis of humeral head according to Cruess standard.Average Constant-Murley score was 83.9 at final follow-up. Conclusion Computer-assisted preoperative planning for proximal humeral fractures using Superimage software can provide a helpful guiding for surgeons in reduction methods for fractures, choice of different internal fixators and placing of implants to obtain good therapy effects.