计算机软件模拟腓骨近端楔形截骨重建外踝的研究

A study on the application of computer software to simulate wedge osteotomy of proximal fibula for external ankle reconstruction

目的通过计算机软件模拟腓骨近端楔形截骨,调整其关节面方向,观察及测量截骨后腓骨近端与原始外踝关节面的解剖学相似度,评估该技术临床应用的可行性及潜在价值。方法收集火箭军特色医学中心40例健康成人单侧下肢CT扫描数据,通过Mimics 20.0软件及3-matic 12.0软件构建腓骨模型,测量腓骨远近端关节面横径、纵径、面积、倾斜角、最长坡径,分析数据差异确定腓骨近端楔形截骨方案。采用计算机软件模拟腓骨近端截骨及外踝重建过程,观察截骨后腓骨近端关节面与外踝关节面拟合满意后,测量截骨后腓骨近端关节面倾斜角及最长坡径并进行统计学分析。结果腓骨三维模型中腓骨近端关节面与腓骨远端关节面的横径差异无统计学意义(P>0.05),腓骨远端关节面纵径、面积、倾斜角、最长坡径大于近端关节面,差异有统计学意义(P<0.05)。腓骨近、远端关节面的面积差值为(107.67±55.55)mm2,面积比值为(63.87±17.50)%;腓骨近、远端关节面的倾斜角差值为(34.69±6.28)°,倾斜角比值为(50.92±8.16)%;腓骨近、远端关节面的最长坡径差值为(4.30±2.76)mm,最长坡径比值为(84.11±9.56)%。截骨后腓骨近端关节面倾斜角为(69.10±4.53)°,而原始腓骨远端关节面倾斜角(70.65±5.14)°,差异无统计学意义(P>0.05)。截骨后腓骨近端关节面最长坡径为(27.63±2.33)mm,而原始腓骨远端关节面最长坡径为(26.78±2.29)mm,差异无统计学意义(P>0.05)。结论采用带关节面腓骨头移植重建外踝是可行的手术方案,通过计算机软件模拟腓骨近端楔形截骨可以确定截骨线的位置,修正腓骨近端关节面方向,消除腓骨近端关节面以远的隆起,更有利于腓骨近端移植重建距腓关节,并且更接近解剖重建。

Objective To observe and measure the anatomical similarity of joint surface between the proximal fibular after os⁃teotomy and the original lateral ankle,and to investigate the feasibility and potential value of the clinical application of this tech⁃nique by simulating a wedge-shaped osteotomy of the proximal fibula and adjusting the direction of articular surface by using computer.Methods The data of the lower limbs CT of 40 adults in PLA Rocket Force Characteristic Medical Center were col⁃lected,and the fibula model was constructed using Mimics and 3-matic.The anatomical data such as the length,width,area,in⁃clination angle,and longest slope diameter of the distal and proximal articular surface of the fibula were measured,and the dif⁃ferences were analyzed to determine the wedge osteotomy plan of the proximal fibula,and then the osteotomy and lateral malleo⁃lus reconstruction process were simulated by computer.After fitting of the proximal articular surface of fibula and the external ankle joint surface was satisfactory,the inclination angle and longest slope diameter of the proximal fibula articular surface after osteotomy were measured and statistically analyzed.Results In the three-dimensional model of the fibula,the difference be⁃tween the transverse diameter of the proximal and distal articular surfaces of the fibula was not statistically significant(P>0.05),and the longitudinal diameter,area,angle of inclination,and longest slope diameter of the distal articular surface of the fibula were greater than those of the proximal articular surface,and the difference was statistically significant(P<0.05).The difference in the area between the proximal and distal articular surfaces was(107.67±55.55)mm2,with an ratio of(63.87±17.50)%.The dif⁃ference in the angle of inclination was(34.69±6.28)°,with an inclination angle ratio of(50.92±8.16)%.The difference in the lon⁃gest slope diameter was(4.30±2.76)mm,with the ratio was(84.11±9.56)%.After osteotomy,the angle of inclination of the proxi⁃mal articular surface was(69.10±4.53)°,compared with the distal articular surface of the fibula(70.65±5.14)°,there was no sig⁃nificant difference(P>0.05).The longest slope diameter of the articular surface of the proximal fibula after osteotomy was(27.63±2.33)mm,while the longest slope diameter of the articular surface of the distal fibula was(26.78±2.29)mm,and the dif⁃ference was not statistically significant(P>0.05).Conclusion It is feasible to reconstruct the external ankle using fibula head transplantation with an articular surface.By simulating the wedge osteotomy of the proximal fibula with computer software,the po⁃sition of the osteotomy line can be determined,the direction of the articular surface of the proximal fibula can be corrected,and the bony eminence near the articular surface of the proximal fibula can be eliminated,which is more conducive to the reconstruc⁃tion of the talofibular joint with the proximal fibula transplantation and helpful for the anatomic reconstruction.