混合现实技术在复杂pilon骨折手术中的初步应用疗效分析

Preliminary application of mixed reality technique in surgery for complex pilon fractures

目的探讨混合现实技术(MR)在复杂pilon骨折手术治疗中的应用价值。方法回顾性分析2018年5月至2020年10月东南大学医学院附属南京同仁医院骨科收治的22例Rüedi-AllgöwerⅢ型pilon骨折患者资料。根据治疗模式不同分为两组:MR组9例,男8例,女1例;年龄(39.2±15.1)岁;在跟骨牵引+切开复位内固定术的基础上,采用MR技术辅助医患沟通、术前规划、手术指导及康复锻炼。对照组13例,全部为男性;年龄(33.7±9.6)岁;单纯采用经典的跟骨牵引+切开复位内固定术。比较两组医患沟通有效性、手术时间、出血量、透视次数、骨折复位程度、并发症和术后1年时的美国足踝外科协会(AOFAS)的踝-后足评分。结果两组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。MR组患者手术知情程度调查问卷分数[(77.8±19.2)分]高于对照组[(50.0±30.6)分],差异有统计学意义(P=0.017);MR组患者透视次数[(7.3±2.6)次]低于对照组[(9.5±2.3)次],差异有统计学意义(P=0.043)。两组患者的手术时间[(98.3±14.4)min、(110.4±20.4)min]、出血量[(118.9±36.5)mL、(128.8±35.2)mL]比较差异无统计学意义(P=0.142,P=0.527)。MR组中解剖复位8例,复位可1例;对照组中解剖复位4例,复位可8例,复位差1例;MR组的解剖复位情况优于对照组,差异有统计学意义(P=0.011)。MR组中伤口延迟愈合1例,骨不连1例,创伤性骨关节炎1例。对照组中伤口延迟愈合2例,浅表软组织感染1例,骨不连1例,创伤性骨关节炎2例。术后1年MR组AOFAS的踝-后足评分[(83.8±9.0)分]显著高于对照组[(73.3±11.8)分],差异有统计学意义(P=0.035),但两组AOFAS的踝-后足评分的优良情况(优6例,良1例,一般2例;优6例,良2例,一般4例,差1例)比较差异无统计学意义(P=0.648)。结论MR能够提高复杂pilon骨折医患沟通的效率、降低术中透视次数、改善复位的质量及踝关节功能,但未能明显减少手术时间和失血量。

Objective To explore application of the mixed reality(MR)technique in the surgery for complex pilon fractures.Methods A retrospective analysis was conducted of the 22 patients with pilon fracture of Rüedi-Allgöwer typeⅢwho had been treated at the Department of Orthopedics,Nanjing Tongren Hospital from May 2018 to October 2020.They were divided into 2 groups according to their treatment procedures.In the MR group of 9 cases,there were 8 males and one female,with an age of(39.2±15.1)years.In addition to calcaneal traction plus open reduction and internal fixation,the MR technique was used to assist doctor-patient communication,preoperative planning,surgical guidance and rehabilitation exercises.In the control group of 13 male cases with an age of(33.7±9.6)years,only conventional calcaneal traction plus open reduction and internal fixation were carried out.The communication efficiency,operation time,intraoperative blood loss,fluoroscopy frequency,fracture reduction,post-operative complications and the American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot score at one year postoperatively were recorded and compared between the 2 groups.Results There was no significant difference in the general data between the MR group and the control group,showing they were comparable(P>0.05).The questionnaire score of patients'surgical awareness[(77.8±19.2)points]in the MR group was significantly higher than that in the control group[(50.0±30.6)points](P=0.017).The fluoroscopy frequency[(7.3±2.6)times]in the MR group was significantly lower than that in the control group[(9.5±2.3)times](P=0.043).No significant differences were observed between the 2 groups in either the operation time[(98.3±14.4)min versus(110.4±20.4)min]or the intraoperative blood loss[(118.9±36.5)mL versus(128.8±35.2)mL](P=0.142,P=0.527).In the MR group,8 cases achieved anatomical reduction and one case good reduction;in the control group,4 cases achieved anatomical reduction,8 cases good reduction and one case poor reduction.The anatomical reduction in the MR group was significantly better than that in the control group(P=0.011).There were one case of delayed wound healing,one case of nonunion,and one case of traumatic osteoarthritis in the MR group while there were 2 cases of delayed wound healing,one case of superficial soft tissue infection,one case of nonunion,and 2 cases of traumatic osteoarthritis in the control group.The average AOFSA ankle-hindfoot score at one year postoperatively in the MR group[(83.8±9.0)points]was significantly higher than that in the control group[(73.3±11.8)points](P=0.035).However,there was no significant difference between the MR group and the control group in the good to excellent rate by the AOFSA ankle-hindfoot score at one year postoperatively(6 excellent cases,one good case,and 2 fair cases in the former versus 6 excellent cases,2 good cases,4 fair cases,and one poor case in the latter)(P=0.648).Conclusions In the surgery for complex pilon fractures,MR technique can increase the efficiency of doctor-patient communication,reduce intraoperative fluoroscopy frequency,and improve reduction quality and ankle function,but fails to significantly reduce operation time and intraoperative blood loss.