数字化技术指导胫骨交锁髓内钉个性化置钉及临床应用研究

目的通过健侧胫骨结合数字化技术制定术前计划，指导临床应用胫骨骨折髓内钉的个性化置钉，评价其疗效。方法2014年10月至2017年10月运用数字化技术指导胫骨骨折髓内钉治疗中个性化置钉并实际应用于病例共34例，分为观察组和对照组。观察组均术前采用数字化技术术前测量髓内钉直径、长度、进针点和胫骨结节垂直胫骨平台沿线距离，在术前选择好合适利用的髓内钉，术中寻找到合理的进针点并实际应用于手术。对照组均采用常规经验置钉的手术方案。术后定期随访，指导功能锻炼，并评定其疗效。结果34例均为单侧胫骨骨折患者，并以交锁髓内钉完成手术，切口均Ⅰ期愈合。术后34例均获随访，随访时间8~15个月，平均13个月；全部骨性愈合，愈合时间14~42周，平均（16．2±1.3）周。平均进针点距离胫骨结节垂直平台沿线距离（6．6±0．7）mm。术后1年按Johner-Wruh评分标准，优23例，良9例，中1例，差1例，优良率94．12％。结论采用数字骨科技术进行术前手术设计，并进行个性化置钉，能够有效减少手术中不必要的操作减少创伤，降低感染率，减少患者的痛苦，增加预后的满意率，是一项值得推广的新技术。

Objective To evaluate the curative effect of the individualized placement of the tibial fracture intramedullary nail guided by the healthy side tibia digital technology. Methods From October 2014 to October 2017, digital technique was used to guide the individualized nail placement in the treatment of tibial fracture intramedullary nail and it was apphed in 34 cases, which were divided into experimental and control groups. In the experimental group , the diameter, length, needle point of the intrameduUary nail and the distance between the tibial tubercle and the tibial plateau were measured before operation by digital technique,and the suitable intramedullary nail was selected before operation. The control group received routine surgical experience. The patients were followed up regularly to guide functional exercise and evaluate its efficacy. Results All the patients with single side tibial fracture were operated with intramedullary nail, all the incision was healed in first stage and followed up by clinic and radiograph for 8-15 （ 13 ） months. Bone healing time was 14~42 （ 16.2 ± 1.3 ） weeks. The distance between the best point oftihial intramedullary nail placement and the line drawn from perpendicular to the tihial plateau of the rihial tuberosity was 6.6 ± 0.7 mm. The function assessed using a scoring system proposed by Johner- Wruh after one year in each patient. The results were classified into the following five groups excellent 23 good 9 fair 1 worse 1, the excellent rate was 94.12%. Conclusion Treatment of tibial fracture with digital technique guide tibial fractures intramedullary nail individual placement has the advantages such as unnecessary operation, less invasion, less Infection, more satisfaction rate, which is an ideal methods.