计算机辅助术前计划在内翻、外翻型Pilon骨折治疗中的应用

Application of computer-assisted preoperative planning in the treatment of Pilon fractures with varus or valgus injury patterns

目的探讨计算机辅助术前计划(CAPP)在内翻、外翻型Pilon骨折治疗中的应用价值。方法回顾性队列研究。纳入2020年9月—2022年8月安庆市立医院创伤中心收治的Pilon骨折患者24例,其中男14例、女10例,年龄23~71(46.5±15.3)岁。骨折损伤类型:内翻型16例,外翻型8例;骨折Ruedi-Allgower分型:Ⅱ型13例,Ⅲ型11例。依据术前是否行CAPP分为2组,其中CAPP组13例,对照组11例。观察项目:(1)比较2组患者的性别、年龄、致伤原因、损伤类型以及骨折Ruedi-Allgower分型等基线资料。(2)比较2组患者手术时间、术中出血量、术中透视次数,以及术中有无血管、神经损等严重并发症发生。(3)术后1周内复查患肢踝关节正侧位X线片,采用Burwell-Charnley评价标准评估并比较2组患者术后骨折复位质量。(4)出院后定期随访,观察2组患者有无切口愈合不良、感染、神经损伤、钢板断裂、再骨折等并发症发生;比较2组患者骨折愈合时间;术后12个月采用美国足踝外科协会(AOFAS)踝-后足评分量表评价并比较2组患者踝关节功能。结果2组患者临床基线资料比较,差异均无统计学意义(P值均>0.05)。2组患者均顺利完成手术,术中无血管、神经损伤等严重并发症发生。CAPP组手术时间、术中出血量、术中透视次数分别为(81.2±6.2)min、(115.4±9.7)mL、(6.6±1.2)次,均少于对照组的(100±16.6)min、(130.5±9.1)mL、(10.6±2.2)次,差异均有统计学意义(t=3.81、3.91、5.60,P值均<0.05)。2组患者术后1周按照Burwell-Charnley骨折复位标准评估复位质量,2组间差异无统计学意义(P=0.675)。2组患者均获随访,随访时间12~18(14.6±1.5)个月。对照组骨折愈合时间为(21.4±2.3)周,CAPP组为(20.0±2.2)周,2组间差异无统计学意义(t=1.53,P=0.159)。术后12个月CAPP组AOFAS踝-后足评分(87.6±3.4)分,高于对照组的(77.5±4.5)分,差异有统计学意义(t=6.24,P<0.001)。随访期间,24例患者除对照组发生1例钢板断裂再次手术外,患者均切口愈合良好,无感染、神经损伤、钢板断裂、再骨折等并发症发生。结论在内翻、外翻型Pilon骨折治疗前,应用CAPP进行术前规划、模拟手术,有助于精准、有效地实施手术,临床疗效满意。

ObjectiveThis study aimed to investigate the application value of computer-assisted preoperative planning(CAPP)in the treatment of Pilon fractures with varus or valgus injury patterns.MethodsThis was a retrospective cohort study.A total of 24 patients with Pilon fractures admitted to the Trauma Center of Anqing Municipal Hospital from September 2020 to August 2022 were enrolled in this study.The patients included 14 males and 10 females,aged 23-71(46.5±15.3)years.In accordance with fracture injury classification,16 cases were varus type and 8 cases were valgus type.In accordance with Ruedi-Allgower classification,13 cases of typeⅡand 11 cases of typeⅢwere identified.Patients were divided into the CAPP group(13 patients)and the control group(11 patients)based on whether CAPP was performed before operation.The observation items were as follows.(1)Baseline data,such as the gender,age,cause of injury,type of injury,and fracture classification of patients in the two groups,were compared.(2)Operation time,intraoperative blood loss,intraoperative fluoroscopy times,and severe intraoperative complications,such as vascular and nerve damage,were compared between the two groups.(3)The anteroposterior and lateral X-ray films of the ankle joint of the affected limb were reexamined within 1 week after operation,and the quality of fracture reduction was evaluated and compared between the two groups in accordance with the Burwell-Charnley evaluation criteria.(4)Patients were followed up regularly after discharge to observe whether complications,such as poor wound healing,infection,nerve injury,plate fracture,and refracture of patients,occurred in the two groups.Fracture healing time was compared between the two groups.The American Orthopedic Foot and Ankle Society(AOFAS)ankle-hindfoot scale was used to evaluate and compare the ankle joint function of the two groups at 12 months after operation.ResultsNo significant differences were found in the clinical baseline data between the two groups(all P values>0.05).All the patients in the two groups successfully completed the operation.No serious complications,such as vascular and nerve injuries,occurred during the operation.Operation time,intraoperative blood loss,and intraoperative fluoroscopy times in the CAPP group were(81.2±6.2)min,(115.4±9.7)mL,and(6.6±1.2)times,respectively,which were less than(100±16.6)min,(130.5±9.1)mL,and(10.6±2.2)times,respectively,in the control group.The differences were not statistically significant(t=3.81,3.91,and 5.60;all P values<0.05).Reduction quality was evaluated in accordance with the Burwell-Charnley fracture reduction criteria at 1 week after operation,and no significant difference was found between the two groups(P=0.675).All the patients were followed up.Follow-up time was 12-18(14.6±1.5)months.Fracture healing time was(20.0±2.2)weeks in the CAPP group and(21.4±2.3)weeks in the control group.No significant difference was noted between the two groups(t=1.53,P=0.159).At 12 months after operation,the AOFAS ankle-hindfoot score of the CAPP group(87.6±3.4)was higher than that of the control group(77.5±4.5),and the difference was statistically significant(t=6.24,P<0.001).During the follow-up period,the incisions of 24 patients healed well,and no complications,such as infection,nerve injury,plate fracture,and refracture,occurred,except for 1 case in the control group who underwent reoperation for plate fracture.ConclusionBefore the treatment of varus or valgus Pilon fractures,the application of CAPP in preoperative planning and simulation surgery is helpful for performing the operation accurately and effectively,and the clinical results are satisfactory.