计算机虚拟手术辅助切开复位内固定治疗复杂肱骨近端骨折

Open reduction and internal fixation assisted by computer virtual surgery in the treatment of complexproximal humeral fracture

目的探讨计算机虚拟手术辅助切开复位内固定治疗复杂肱骨近端骨折的疗效。方法采用回顾性病例系列研究分析2018年1月至2020年6月同济大学附属东方医院收治的36例复杂肱骨近端骨折患者临床资料, 其中男13例, 女23例;年龄22~86岁[(56.4±4.8)岁]。均为闭合性骨折。骨折Neer分型:三部分骨折20例, 四部分骨折16例。应用E-3D数字化骨科软件进行精准虚拟手术设计, 根据手术计划实施精确骨折复位锁定接骨板内固定手术。记录骨折愈合情况;比较虚拟手术和术后1 d肱骨颈干角和肱骨头高度, 评估依据虚拟手术设计实施手术的效果;比较术后1 d、3个月及12个月肱骨颈干角和肱骨头高度;比较术后1 d、3个月及12个月肩关节活动度(外展、外旋及前屈)、Constant肩关节功能评分及视觉模拟评分(VAS);评估术后1 d内侧柱的稳定性;记录并发症发生情况。结果患者均获随访12~38个月[(18.5±1.8)个月]。患者均骨性愈合, 骨折愈合时间为6.6~17.2周[(10.2±1.0)周]。虚拟手术与术后1 d肱骨颈干角和肱骨头高度差异无统计学意义(P均>0.05)。术后1 d、3个月及12个月肱骨颈干角和肱骨头高度差异无统计学意义(P均>0.05)。术后3个月及12个月肩关节外展为(119.4±11.8)°、(155.3±13.7)°, 外旋为(37.6±6.3)°、(46.8±7.4)°, 前屈为(94.8±10.2)°、(126.9±1.6)°, 高于术后1 d的(53.8±4.5)°、(21.6±3.3)°、(44.6±7.8)°(P均<0.05)。术后3个月及12个月Constant肩关节功能评分为(66.8±8.4)分、(82.4±9.6)分, 高于术后1 d的(34.3±6.1)分(P均<0.05)。术后3个月及12个月VAS为(4.1±0.5)分、(1.2±0.2)分, 低于术后1 d的(8.3±1.4)分(P均<0.05)。术后1 d 34例内侧柱稳定, 2例不稳定。1例出现螺钉切出关节面, 1例出现肱骨头坏死。结论应用计算机虚拟手术辅助切开复位内固定治疗复杂肱骨近端骨折, 有利于术后复位维持, 促进关节功能恢复并缓解疼痛, 减少并发症。

Objective To investigate the effect of open reduction and internal fixation assisted by computer virtual surgery in the treatment of complex proximal humeral fracture.Methods A retrospective case series study was performed on clinical data of 36 patients with complex proximal humeral fracture admitted to Dongfang Hospital Affiliated to Tongji University from January 2018 to June 2020.There were 13 males and 23 females,aged 22-86 years[(56.44.8)years].They were all closed fractures.According to Neer classification,there were 20 patients with three-part fractures and 16 with four-part fractures.Precise pre-surgical designs made by using the digital orthopedic surgery planning system of the E-3D were applied to assist the implementation of precise fracture reduction and internal fixation with the locking plate.The fracture healing was observed.The effect of the real surgery assisted by the virtual surgical designs was assessed by comparing the humeral neck shaft angle and humeral head height measured at the virtual surgery and at day 1 after the real surgery.The humeral neck shaft angle,humeral head height,shoulder range of motion(abduction,external rotation and forward flexion),Constant shoulder function score and visual analogue score(VAS)were recorded at 1 day,3 months and 12 months after the real surgery.The stability of the medial column was assessed at 1 day after the real surgery.The complications were recorded.Results All patients were followed up for 12-38 months[(18.5±1.8)months].The fracture showed bony union in all patients with the union time of 6.6-17.2 weeks[(10.2±1.0)weeks].The humeral neck shaft angle and humeral head height showed no significant differences measured at the virtual surgery and at 1 day after the real surgery,and were also not significant different at 1 day,3 months and 12 months after the real surgery(all P>0.05).At 3 months and 12 months after the real surgery,the shoulder abduction[(119.4±11.8)°,(155.3±13.7)°],external rotation[(37.6±6.3)°,(46.8±7.4)°],forward flexion[(94.8±10.2)°,(126.9±1.6)°]and Constant function score[(66.8±8.4)points,(82.4±9.6)points]were all higher than those at 1 day after the real surgery[(53.8±4.5)°,(21.6±3.3)°,(44.6±7.8)°,(34.3±6.1)points],while the VAS[(4.1±0.5)points,(1.2±0.2)points]was lower than that at 1 day after the real surgery[(8.3±1.4)points](all P<0.05).The medial column was stable in 34 patients and unstable in 2 at 1 day after the real surgery.Complications included screw cutting out in the articular surface in 1 patient and humeral head necrosis in 1.Conclusion Treatment of complex proximal humeral fractures with open reduction and internal fixation assisted by computer virtual surgery is conducive to maintaining reduction effect,promoting shoulder joint function,relieving pain and reducing complications.