计算机辅助术前计划在AO/OTAC型股骨远端骨折治疗中的应用价值

Computer-assisted preoperative planning in the treatment of AO/OTA type-C distal femur fractures

目的探讨计算机辅助术前计划(computer-assisted preoperative planning,CAPP)在治疗AO/OTAC型股骨远端骨折中的应用价值。方法回顾性分析2010年1月至2021年12月采用股骨远端微创固定系统(lessinvasivestabilization system-distal femur,LISS-DF)治疗AO/OTAC型股骨远端骨折患者150例,根据是否采用计算机辅助术前计划将患者分为非CAPP组和CAPP组。非CAPP组81例,男56例、女25例,年龄(54.9±5.8)岁(范围39~67岁),C1型22例、C2型35例、C3型24例。CAPP组69例,男50例、女19例,年龄(53.9±4.6)岁(范围45~63岁),C1型18例、C2型28例、C3型23例。记录术前计划所需时间,比较两组患者的手术时间、术中出血量、术中透视次数、住院天数。末次随访时采用美国特种外科医院(Hospital forSpecial Surgery,HSS)膝关节功能评分和疼痛视觉模拟评分(visual analogue scale,VAS)评估膝关节功能。结果CAPP组术前计划耗时(22.4±3.4)min(范围17~31min)。CAPP组手术时间为(94.4±6.3)min、术中出血量为(224.1±22.0)ml、术中透视次数为(6.7±2.2)次、住院天数为(6.4±1.9)d,分别低于非CAPP组的(110.9±7.7)min、(299.3±34.2)ml、(11.3±3.1)次、(12.8±3.2)d两组比较差异均有统计学意义(P<0.001)。所有患者均获得随访,其中CAPP组随访时间为(17.7±3.3)个月、非CAPP组为(18.1±3.7)个月。两组患者骨折均获临床愈合,CAPP组和非CAPP组患者骨折愈合时间分别为(13.9±1.1)周和(14.0±1.3)周,差异无统计学意义(t=0.699,P=0.490)。末次随访时CAPP组患者HSS膝关节功能评分为(86.6±3.4)分、VAS评分为(0.9±0.4)分,优于非CAPP组的(79.2±5.1)分和(1.3±0.5)分,两组比较差异均有统计学意义(P<0.001)。两组患者均无一例发生骨折延迟愈合、骨不连、内固定失败等相关并发症。结论采用LISS-DF钢板治疗复杂股骨远端骨折时,CAPP可协助术者高效、精准地完成术前设计;与传统术前计划相比可减少手术时间、降低手术创伤,并获得更加满意的术后疗效。

Objective To investigate the application value of computer-assisted preoperative planning(CAPP)in the treatment of AO/OTA type-C distal femoral fractures.Methods A retrospective analysis was conducted on 150 patients with AO/OTA type-C distal femur fractures from January 2010 to December 2021 using the less invasive stabilization system-distal femur(LISS-DF).Patients were divided into a non-CAPP group and a CAPP group based on whether computer-assisted preoperative plan-ning was utilized.The non-CAPP group included 81 patients(56 males,25 females)with an age range of 39 to 67 years(mean 54.9±5.8 years),consisting of 22 type-C1 fractures,35 type-C2 fractures,and 24 type-C3 fractures.The CAPP group comprised 69 patients(50 males,19 females)with an age range of 45 to 63 years(mean 53.9±4.6 years),including 18 type-C1 fractures,28 type-C2 fractures,and 23 type-C3 fractures.The study recorded the time of preoperative planning and compared the surgical duration,intraoperative blood loss,times of fluoroscopy intraoperatively,and hospital stay length between the two groups.At the last follow-up,knee function was evaluated using the Hospital for Special Surgery(HSS)knee score and pain was assessed using the visual an-alogue scale(VAS).Results The preoperative planning time of CAPP was 22.5+3.4 min(range,17-31 min).There were statisti-cally significant differences between non-CAPP group and CAPP group in terms of surgical duration(non-CAPP,110.9+7.7 min;CAPP,94.4±6.3 min),intraoperative blood loss(non-CAPP,299.3±34.2 ml;CAPP,224.1±22.0 ml),times of fluoroscopy intraoper-atively(non-CAPP,11.3±3.1;CAPP,6.7±2.2),and hospital stay length(non-CAPP,12.8±3.2 d;CAPP,6.4±1.9 d)(P<0.001).All patients were followed up,with the CAPP group having a follow-up duration of 17.7+3.3 months and the non-CAPP group having 18.1±3.7 months.Both groups of patients achieved clinical healing of fractures.The healing time for fractures in the CAPP group and the non-CAPP group were 13.9±1.1 weeks and 14.0±1.3 weeks,respectively,with no statistically significant difference(t=0.699,P=0.490).At the last follow-up,the average HSS score and VAS score of the patients in the CAPP group were 86.63.4 points and 0.9±0.4 points,which were both better than those of the non-CAPP group 79.2±5.1 points and 1.3±0.5 points(P<O.001).No patients in either group experienced complications related to delayed fracture healing,nonunion,or internal fixation failure.Conclusion When using LISS-DF steel plate to treat complex distal femoral fractures,CAPP can assist the operator in efficiently and accurately completing preoperative design.Compared with traditional preoperative planning,it can reduce surgical time,surgical trauma,and achieve more satisfactory postoperative outcomes.