基于Mimics三维重建个性化锁骨钩钢板塑形技术及疗效分析

Personalized Clavicular Hook Plate Shaping Technology Based on Mimics 3D Reconstruction and Its Clinical Efficacy

目的利用Mimics软件对肩锁关节结构行三维重建及测量,进而量化指导锁骨钩钢板塑形,并与传统经验性塑形钢板比较研究其临床疗效。方法选取2018年3月至2020年3月徐州医科大学附属宿迁医院骨科连续收治42例肩锁关节脱位患者作为研究对象,2019年7月以后的24例作为实验组,2019年7月以前的18例作为对照组。实验组男13例,女11例;年龄25~63岁,平均(44.9±11.1)岁;左侧10例,右侧14例。利用Mimics软件术前三维重建并测量健侧肩锁关节区α、β、γ角和A~A'长度四个参数,从而量化指导钢板个性化塑形。对照组男10例,女8例;年龄23~62岁,平均(44.1±12.0)岁;左侧8例,右侧10例。由医生依据经验对锁骨钩钢板塑形。两组患者均采用Constan-Murley肩关节功能评分和疼痛数字评分法(numeric rating scale,NRS)对手术前、后肩功能和疼痛程度进行评估。结果两组患者术前一般情况、肩关节功能评分及NRS评分比较,差异无统计学意义。实验组术后3d肩关节功能评分及NRS疼痛评分较术前明显下降(P<0.05);术后1、3、6个月,两组NRS疼痛评分较术前均呈明显下降趋势(P<0.001),实验组较对照组NRS疼痛评分更低(P<0.05、P<0.05、P<0.05);术后1、3、6个月实验组功能恢复均更显著(P<0.01、P<0.01、P<0.05)。结论术前利用Mimics软件测量α、β、γ角和A~A'长度量化指导锁骨钩钢板塑形,可显著降低肩锁关节脱位术后肩部疼痛,提高肩关节功能,具有重要临床价值。

Objective To perform three-dimensional(3D)reconstruction and measurement of the acromioclavicular joint dislocation(AJD)structureusing Mimics software,quantitatively guide the shaping of the clavicular hook plate(CHP),and compare its clinical efficacy with the traditional empirical shaping plate.Methods 42 consecutive patients with AJD diagnosed in the Department of Orthopedics,Suqian Hospital Affiliated to Xuzhou Medical University between March 2018 to March 2020 were included and categorized.The experimental group has 13 males and 11 females,including 10 casesof left and 14 cases ofthe right shoulders.The patients aged from^(2)5 to 63 years old with an average age of(44.9±11.1)years old.Using Mimics,3D reconstruction and measurement of the healthy side AJD zone ofα,β,γangle and length of A-A'four parameters before operation were conducted.CHP personalized shaping was guided quantitatively.The control group has 10 males and 8 females,include 8 left and 10 right cases,which the age ranged from^(2)3 to 62 years,with an average of(44.1±12.0)years.CHP was shaped by operators according to experience.Constan-Murley shoulder function score(C-MSF)and the numeric rating scale(NRS)were used to evaluate the shoulder function and pain respectively before and after the operation for both groups.Results There was no statistically significant difference in preoperative general conditions,C-MSF and NRS scores between the two groups.In experimental group,it was significantly lower in C-MSF and NRS scores than that of preoperative at 3 days after operation(P<0.05).At 1,3,and 6 months after operation,the NRS scores of the two groups showed a significant decline compared with preoperative(P<0.001).The experimental group had lower pain scores than control group(P<0.05,P<0.05,P<0.05),and the functional recovery of experimental group was more significant at 1,3,and 6 months respectively after surgery(P<0.01,P<0.01,P<0.05).Conclusion The preoperative measurement ofα,βandγangles and length of A-A'using Mimics software can significantly reduce shoulder pain and promote the recovery of shoulder joint function after CHP surgery of AJD,which has important clinical value.