数字化模型辅助微创钢板接骨术治疗胫骨远端骨折

Digital Model Assisted Minimally Invasive Plate Osteosynthesis for Distal Tibial Fractures

目的探讨运用数字化模型辅助微创钢板接骨术(minimally invasive plate osteosynthesis,MIPO)治疗胫骨远端骨折的疗效。方法回顾性分析我院2016年1月～2017年3月胫骨远端骨折48例资料,其中常规MIPO 27例(常规组),数字化模型辅助MIPO 21例(数字组)。数字组术前行胫骨全长CT薄层扫描,并将DICOM格式图像导入Mimics17.0软件,建立数字化模型。通过模拟手术骨折复位内固定,测量骨折块之间的相对位移及钢板、螺钉的尺寸、位置、数量,指导MIPO手术操作。比较2组手术时间、术中出血量、骨折愈合时间及术后疗效。结果数字组都建立了个体化的胫骨骨折数字化模型,并可用于模拟手术、获取相关数据指导MIPO手术操作。手术时间数字组<常规组[(61.2±9.4)min vs.(67.5±10.4)min,t=2.174,P=0.035]。术中出血量数字组<常规组[(25.6±8.4)ml vs.(31.4±10.2)ml,t=2.141,P=0.038]。骨折愈合时间数字组<常规组[(15.1±2.4)周vs.(16.8±2.1)周,t=2.659,P=0.011]。根据Johner-Wruhs评价标准,术后3个月疗效数字组优于常规组(P<0.05)。结论根据CT薄层扫描图像可建立精确的数字化模型,用于模拟手术可以提供准确的参考数据,辅助MIPO手术可使手术时间更短,出血量更少,并发症发生率更低,骨折愈合时间更短,术后早期优良率更高。

Objective To explore the application and effect of digital model assisted minimally invasive plate osteosynthesis（ MIPO） in the treatment of distal tibial fracture. Methods A retrospective study was performed on 48 cases of distal tibial fracture patients in our hospital from January 2016 to March 2017 who were divided into two groups according to the treatment plan： the conventional MIPO group（ conventional group,n = 27） and digital model assisted MIPO group（ digital group,n = 21）. Thin-section helical CT scans were performed to the full length tibials for the latter group,and the DICOM format images were imported into the Mimics 17. 0 software to establish a digital model. By simulating the reduction and internal fixation of minimally invasive plate osteosynthesis for the fractures,the relative displacement between fracture blocks,the size and location and quantity of plates and screws were measured to guide operation process. The operating time,intraoperative blood loss,fracture union time and postoperative effect were compared between the two groups. Results Individualized tibial fracture digital models of 21 patients in the digital group had been established,which were used for simulating surgery and obtaining relevant data to guide MIPO operation. The operating time showed that digital group conventional group [（ 61. 2 ± 9. 4） min vs.（ 67. 5 ± 10. 4） min,t = 2. 174,P = 0. 035]. The intraoperative blood loss showed that digital group 〈conventional group [（ 25. 6 ± 8. 4） ml vs.（ 31. 4 ± 10. 2） ml,t = 2. 141,P =0. 038]. The fracture union time showed that digital group 〈conventional group [（ 15. 1 ± 2. 4） weeks vs.（ 16. 8 ± 2. 1） weeks,t =2. 659,P = 0. 011]. According to the Johner-Wruhs criteria,the curative effect of the digital group was better than that of the conventional group at 3 months after surgery（ P 0. 05）. Conclusion Digital models can be established precisely according to the CT scan images and be used for surgical simulation to provide accurate reference data,which is helpful in performing MIPO operation due to the following advantages： shorter operating time,less bleeding,shorter fracture union time and better curative effect at the early postoperative stage.