基于三维骨折地图技术的跟骨骨折线分布研究

Study on the distribution of calcaneal fracture line based on three-dimensional fracture map technology

背景:跟骨骨折在其解剖、生物力学、损伤机制等方面复杂性极高,治疗难度大。现有的骨折分类系统多样,临床选择尚不统一。近年来骨折地图绘制技术愈发完善,临床研究逐渐增多,为全身各部位骨折的骨折特征及损伤机制提供了新的研究思路。目的:绘制跟骨骨折线图并转化为热图,分析跟骨骨折特征。方法:回顾性研究68例(74足)跟骨骨折患者的病例资料。选取一位34岁健康男性(右侧)跟骨CT扫描数据,进行三维重建,作为骨折线绘制模板。将68例患者足踝CT扫描数据导入Mimics 20.0软件,重建三维骨折模型,再将骨折模型导入3-matic 12.0软件,模拟骨折复位并与标准模板拟合,在标准模板上临摹骨折线,创建骨折线图并转化为热图,分析骨折特征。结果与结论:(1)跟骨骨折患者年龄大多分布于44-55岁,其中男性患者占85.3%,女性病例占14.7%;(2)跟骨骨折地图明显可见3条弧形带状高发区,A带:外侧壁环形高发区;B带:包含整个Gissane角并向外侧结节与底部交接处走行;C带:从后距关节面中间向后内侧走行,在内侧壁靠结节部向前部延伸;(3)结果表明,骨折地图能直观展现跟骨骨折特征,在跟骨的进一步分型、内固定设计、置钉策略、有限元分析的有效性验证等方面可以提供参考。

BACKGROUND:Calcaneal fractures are extremely complex in terms of anatomy,biomechanics,and injury mechanisms,and are difficult to treat.The existing fracture classification systems are diverse,and the clinical selection is not uniform.In recent years,fracture mapping technology has become more and more perfect,and clinical research has gradually increased,providing new research ideas for fracture characteristics and injury mechanisms of fractures in various parts of the body.OBJECTIVE:To draw a calcaneal fracture line map and convert it into a heat map to analyze the characteristics of calcaneal fractures.METHODS:The case data of 68 patients(74 feet)with calcaneal fractures were retrospectively studied.The CT scan data of the right calcaneus of a 34-yearold healthy male were selected for three-dimensional reconstruction and used as a template for drawing fracture lines.CT scan data of foot and ankle of 68patients were imported into Mimics 20.0 software to reconstruct a three-dimensional fracture model.The fracture model was imported into 3-matic 12.0software to simulate fracture reduction and to fit with the standard template.The fracture line was traced on the standard template.A fracture line map was created and converted into a heat map to analyze the fracture characteristics.RESULTS AND CONCLUSION:(1)Most of the patients with calcaneal fractures were 44-55 years old,of which 85.3%were male and 14.7%were female.(2)Three arc-shaped high-incidence areas were clearly visible on the map of calcaneal fractures.A belt:the annular high-incidence area of the lateral wall;B belt:covering the entire angle of Gissane and running towards the junction of the lateral tubercle and the bottom;C belt:from the middle of the posterior talar articular surface runs posteriorly and medially,and extends anteriorly by the tubercle in the medial wall.(3)The results show that the fracture map can directly display the characteristics of calcaneal fractures,and can provide references for further classification of calcaneus,internal fixation design,nail placement strategy,and finite element analysis validation.