结合Mimics软件三维重建测量的肩胛骨关节外骨折手术疗效分析

Treatment of extra-articular scapular fractures with assistance of 3D reconstruction measurements with Mimics software

目的探讨肩胛骨关节外骨折的影像学评估方法及手术疗效。方法回顾性分析2014年1月至2020年1月北京积水潭医院创伤骨科收治并完整随访的19例(男17例,女2例;平均年龄41岁)肩胛骨关节外骨折患者资料(试验组)。应用Mimics16.0软件对肩胛骨关节外骨折进行三维重建,测量并记录肩胛骨骨折内外方向移位距离、前后方向成角及盂极角。将同期同龄的19例肱骨近端骨折患者(男17例,女2例;平均年龄41岁)无骨折的肩胛骨三维重建作为对照组进行影像学比较。试验组患者采用改良Judet入路进行手术。记录试验组患者术后6个月的Constant-Murley绝对值评分以评估功能。结果试验组所有患者术后获平均48个月(11~73个月)随访,骨折均在术中获解剖复位固定,并在术后6个月内获骨性愈合。试验组患者术前内外方向移位距离平均17.9 mm,前后方向成角平均26.9°;术后6个月前屈上举角度平均162.2°,体侧外旋角度平均41.6°,Constant-Murley绝对值评分平均为93.2分。术前试验组与对照组患者盂极角分别为34.4°±6.3°、40.6°±6.6°,两组间比较差异有统计学意义(P<0.05)。术后6个月试验组患者盂极角为38.4°±5.0°,与术前比较差异有统计学意义(P<0.05)。结论结合Mimics软件进行三维重建测量有助于准确判断肩胛骨关节外骨折的特征并评估手术指征。通过改良Judet入路进行切开复位内固定治疗,患者可以获得满意的骨折愈合率和功能结果。

Objective To investigate a 3D method of radiological evaluation of extra-articular scapular fracture and the treatment outcomes.Methods A total of 19 patients with extra-articular scapular fracture were operatively treated and completely followed up at Department of Orthopaedics and Traumatology,Beijing Jishuitan Hospital from January 2014 to January 2020.They were 17 males and 2 females with an average age of 41 years(from 24 to 65 years).The medial-lateral displacement,antero-posterior angulation and glenopolar angle were measured on images of 3D reconstruction of the fractured scapulae by Mimics software.3D reconstructions of the intact scapulae were made as controls in the patients with proximal humerus fracture matched in time and age(17 males and 2 females with an average age of 41 years).Operations were carried out via the modified Judet approach in the experimental group.The treatment outcomes in the experimental group were evaluated by the Constant-Murley absolute value scoring at 6 months after operation.Results All the patients in the experimental group obtained a mean follow-up of 48 months(from 11 to 73 months).All fractures in the experimental group acquired anatomical reduction and fixation intraoperatively and bony union within 6 months after operation.In the experimental group,the medial-lateral displacement averaged 17.9 mm and the antero-posterior angulation 26.9°before operation while the anteflexion lifting angle 162.2°,the lateral external rotation 41.6°,and the Constant-Murley absolute value scores 93.2 points at 6 months after operation.Pre-operatively,the glenopolar angles were 34.4°±6.3°and 40.6°±6.6°for the experimental and control groups respectively,showing a significant difference between the 2 groups(P<0.05).At 6 months after operation,the glenopolar angle was 38.4°±5.0°for the experimental group,showing a significant difference between pre-and post-operation(P<0.05).Conclusions 3D reconstruction measurements with Mimics software help accurate characterization of extra-articular scapular fracture and evaluation of surgical indications.Open reduction and internal fixation of scapular fractures via the modified Judet approach may promise a satisfactory union rate and functional outcomes.