基于计算机辅助术前计划的胫骨远端内侧单钢板结合拉力螺钉治疗pilon骨折

The treatment of pilon fractures with a single medial locking plate and lag screwsbased on computer-assisted pre-operation plan

目的探讨基于计算机辅助术前计划的胫骨远端内侧单钢板结合拉力螺钉治疗pilon骨折的疗效。方法回顾性分析2013年1月至2016年12月,应用胫骨远端内侧钢板结合拉力螺钉治疗27例pilon骨折患者资料,男16例,女11例;年龄21~67岁,平均47.7岁;按AO/OTA分型,均为43-C型;按Rüedi-Allgower分型:Ⅱ型5例,Ⅲ型22例;其中19例合并腓骨骨折。所有病例术前均采用计算机辅助术前计划进行损伤细节分析、骨折模拟复位、虚拟手术评估。记录术前计划所需时间,评估术前计划在术中的实现情况;记录手术时间、术中出血量及术前、术后踝关节活动度。末次随访采用美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝-后足评分、视觉模拟评分(visual analogue scale,VAS)评估临床疗效。结果计算机辅助术前设计总耗时平均25.8 min(范围,14~30 min)。所有患者术前设计方案在术中均顺利实施,平均手术时间(138.5±27.0)min,术中出血量(225.9±87.0)ml。27例患者均获得随访,随访时间12~27个月,平均(18.6±4.1)个月。末次随访时,踝关节活动度较术前明显改善;AOFAS踝-后足评分平均为(82.9±12.1)分,VAS评分为(2.7±1.6)分,均较术前明显改善,术前及术后比较差异均有统计学意义(t=-19.358,7.720;均P<0.001)。结论采用计算机辅助术前计划系统操作可高效、便捷、快速制定pilon骨折的虚拟手术计划,同时可在术中有效辅助精准实施胫骨内侧单钢板结合拉力螺钉治疗C型pilon骨折,并取得满意的临床疗效。

Objective evaluate the efficacy of a single medial locking plate and lag screws based on computer-assisted pre-operation plan(CAPP)for the treatment of pilon fractures.Methods Between 2013 and 2016,data of 27 patients with pilon fractures who were treated using a single medial locking and lag screws based on CAPP were retrospectively analyzed.All the cases were AO/OTA 43-C type pilon fractures.According to the Rüedi-Allg?wer classification,there were 5 cases of typeⅡand 22 cases of typeⅢ.Among 27 patients,19 patients had fibula fracture.CAPP was performed for all fractures,including simulated reduction,virtual surgery,and implantation of internal fixation.The time of CAPP,intraoperative realization of preoperative plan,operation time,intraoperative blood loss,and pre-and post-operative range of motion of ankle were recorded.Functional outcomes at final follow up were assessed using American Orthopedic Foot and Ankle Society(AOFAS)ankle hindfoot scale,visual analogue scale(VAS).Results The mean time of CAPP was 25.8 minutes(range,14-30 minutes).The average operating time was 138.5 minutes.The average intraoperative blood loss was 225.9 ml.All the twenty-seven patients were followed up for an average period of 18.6 months.The average AOFAS score,VAS score at the final follow-up was 82.9,2.7 points respectively,which was significantly improved compared with those before operation(t=-19.358,7.720;all P<0.001).Conclusion CAPP system is convenient and efficient,which can facilitate the treatment of type C pilon fractures with a single medial locking plate and lag screws.In addition,satisfactory clinical outcomes can be obtained.