基于3D虚拟与仿真技术辅助经皮微创治疗SandersⅡ、Ⅲ型跟骨关节内骨折临床研究

Clinical Study on Percutaneous Minimally Invasive Treatment for Sanders Type Ⅱ and Ⅲ Intraarticular Calcaneal Fractures Based on 3D Virtual and Simulation Technology

目的 探讨基于3D虚拟与仿真技术辅助经皮微创治疗SandersⅡ、Ⅲ型跟骨关节内骨折临床研究。方法 选择2021年9月-2022年9月中山南朗医院骨科住院部收治的SandersⅡ、Ⅲ型跟骨骨折患者70例,随机分成两组,对照组35例患者采取外侧“L”形切口治疗,研究组35例患者采用3D虚拟与仿真技术微创治疗。术后比较两组患者置钉参数与实际值的差异,比较两组患者间载距突平均置钉数、螺钉分布、准确率、置钉用时、手术时间、术中出血量、伤口并发症发生率及骨折愈合时间和术后1年足功能Maryland评分,并收集数据,比较其临床效果。结果 研究组术中出血量、手术时间、住院天数以及骨折愈合时间均、总置钉数、平均置钉数、准确率、每钉置钉时间、每组置钉时间、术后并发症发生率均低于对照组,差异具有统计学意义(P<0.05);随访1年后研究组患者疼痛评分、功能评分以及足功能Maryland总评分与对照组并无明显统计学差异(P>0.05)。结论 基于3D虚拟与仿真技术辅助经皮微创治疗SandersII、Ⅲ型跟骨关节内骨折可提升置钉质量和生物力学稳定性,改善患者的足功能恢复效果,但是该技术仍存在一定的技术缺陷,无法完全恢复骨折前的结构以及解剖学形态,另外图像的处理技术要求较高,需进一步提升技术支持。

Objective To explore clinical study of percutaneous minimally invasive treatment for Sanders typeⅡandⅢintra articular calcaneal fractures based on 3D virtual and simulation technology.Methods The paper chose 70 patients with SandersⅡandⅢtype calcaneal fractures admitted to orthopedic inpatient department of Zhongshan City Nanlang Hospital from September 2021 to September 2022,and divided them into two groups randomly.35 cases in control group were treated with lateral"L"incision treatment,while 35 cases in study group with minimally invasive treatment with 3D virtual and simulation technology.After surgery,difference of nail placement parameters and actual values between two groups were compared.Average number of screws placed in distance process,screw distribution,accuracy,nail placement time,surgical time,intraoperative bleeding,incidence of wound complications and fracture healing time,as well as the Maryland scores of foot function one year after surgery between two groups were compared,clinical effect was compared based on data collection.Results Intraoperative bleeding volume,surgical time,length of hospital stay and fracture healing time,total number of nails,average number of nails,accuracy,time for each nail,time for each group of nails and incidence of postoperative complications in study group was lower than control group,with statistically significant difference(P<0.05).After one year of follow-up,there was no significant statistical difference between study group and control group in terms of pain scores,functional scores and total Maryland foot function scores(P>0.05).Conclusion Percutaneous minimally invasive treatment based on 3D virtual and simulation technology can improve quality of nail placement,biomechanical stability,foot function recovery effect of patients with SandersII andⅢintra-articular calcaneal fractures.However,the technology still has some certain technical defects,can not fully restore structure and anatomical form before the fracture.In addition,it has high requirements for image processing technology,further technical support is needed.