Mimics虚拟术前规划辅助MIPPO治疗Ⅱ、Ⅲ型Pilon骨折的临床效果

Clinical research on mimics virtual preoperative design assisting MIPPO in treating Ⅱ/Ⅲ type pilon fracture

目的:探讨Mimics 17.0软件虚拟术前规划辅助微创经皮钢板内固定(minimally invasive percutaneous plate osteosynthesis,MIPPO)治疗Ⅱ、Ⅲ型高能量Pilon骨折的应用价值。方法:纳入内蒙古自治区人民医院创伤骨科2013年1月至2016年3月接受经皮微创钢板内固定术治疗的Ⅱ、Ⅲ型高能量Pilon骨折患者共40例为研究对象,随机分成观察组和对照组,每组各20例,对照组患者常规进行经皮微创钢板内固定术;观察组患者应用Mimics 17.0软件进行三维数字化模型重建后进行术前规划,并按规划结果指导进行经皮微创钢板内固定术。对比两组患者手术操作时间、术中出血量、X线透视次数、术后骨折复位情况、术后软组织并发症、骨折愈合时间、术后踝关节功能恢复情况等。结果:最后一次随访时,两组患者均达到了骨性愈合,均未发生下肢短缩畸形、骨不连、关节功能明显障碍、退钉、断钉等情况,组间比较差异无统计学意义(P>0.05);观察组患者手术时间、出血量和X线暴露剂量、术后早期并发症发生率方面低于对照组(P<0.05);但在术后晚期并发症、骨折愈合时间以及踝关节功能等方面上,两组患者比较差异无统计学意义(P>0.05)。结论:Mimics虚拟术前规划技术辅助MIPPO治疗Ⅱ、Ⅲ型Pilon骨折,能提高手术效果、降低术后并发症,可常规应用并推广。

Objective：To explore the application value of Mimiesl7.0 virtual preoperative planning assisted minimally invasive percntaneous plate osteosynthesis （MIPPO） in the treatment of Ⅱ/Ⅲ type high energy Pilon fractures. Methods：40 cases of patients of Ⅱ/Ⅲ type high - energy Pilon fracture who were treated with MIPPO in the Traumatic Department of Orthopedics of Inner Mongolia Autonomous Region People＇s Hospital from January 2013 to March 2016 were selected and randomly divided into two groups, 20 cases in each group. The control group was given the conventional MIPPO, and the experiment group used Mimics 17.0 software to rebuild 3D digital model and then performed MIPPO with the guidance of the simulated results. The operation time, blood loss, amount of X -ray, postoperative condition of reposition, soft tissue complications, fracture healing time, ankle joint function and so on were compared in the two groups. Results： In the last follow - up, all the patients reached bone healing, without lower limb shortening deformity, nonunion, joint disfunction, back nail, nail broken and so on, and there was no significant difference in the two groups （ P 〈 0.05）. The operation time, bleeding volume and X light exposure dose, the incidence rate of early postoperative complications in the observation group was significantly lower than those in the control group （ P 〈0.05） ; there was no significant difference in the late postoperative complications, fracture healing time and ankle joint function between the two groups （ P 〉 0.05 ）. Conclusion： Mimics virtual surgical planning technology assisted MIPPO in the treatment of Ⅱ/Ⅲ type Pilon fracture can improve the operation effect and reduce the postoperative complications, which can be routinely applied and popularized.