[1]吴青松,孙鹏,李立,等.数字骨科技术辅助切开复位内固定术治疗 跟骨骨折的临床研究[J].中医正骨,2015,27(12):20-23.
 WU Qingsong,SUN Peng,LI Li,et al.Clinical study on open reduction internal fixation assisted by digital orthopaedic technique in the treatment of calcaneal fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(12):20-23.
点击复制

数字骨科技术辅助切开复位内固定术治疗 跟骨骨折的临床研究()
分享到:

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第27卷
期数:
2015年12期
页码:
20-23
栏目:
临床研究
出版日期:
2015-12-30

文章信息/Info

Title:
Clinical study on open reduction internal fixation assisted by digital orthopaedic technique in the treatment of calcaneal fractures
作者:
吴青松孙鹏李立韩明涛
山东省文登整骨医院,山东 文登 264400
Author(s):
WU QingsongSUN PengLI LiHAN Mingtao
Wendeng Osteopath Hospital,Wendeng 264400,Shandong,China
关键词:
跟骨 数字骨科 3D打印 骨折固定术 治疗临床研究性
Keywords:
calcaneus digital orthopedics 3D printing fracture fixationinternal therapiesinvestigational
摘要:
目的:探讨数字骨科技术在跟骨骨折切开复位内固定术中的应用价值。方法:将44例符合要求的跟骨骨折患者随机分为数字技术组和传统手术组,每组22例。数字技术组术前利用Mimics 15.0软件及跟骨3D打印模型进行模拟复位和手术,确定钢板种类、位置及螺钉的位置和长度,同时对钢板进行塑形,术中按照根据模拟手术制定的手术方案进行切开复位内固定手术; 传统手术组按照传统方式进行切开复位内固定术。比较2组患者的切口长度、手术时间、出血量、术中X线透视次数、住院时间及骨折复位情况。结果:数字技术组的术中X线透视次数和手术时间均少于传统手术组[(7.4±3.6)次,(10.4±2.6)次,t=3.144,P=0.003;(51.0±7.7)min,(57.8±9.6)min,t=2.580,P=0.013],2组患者的出血量、切口长度、住院时间比较,组间差异均无统计学意义[(25.4±3.8)mL,(26.6±4.3)mL,t=1.043,P=0.303;(12.4±1.3)cm,(13.0±1.2)cm,t=1.831,P=0.074;(10.5±2.3)d,(10.4±1.7)d,t=0.226,P=0.823]。按照Burwell-Charnley放射学评价标准,数字技术组解剖复位15例、复位一般3例、复位差4例,传统手术组解剖复位12例、复位一般2例、复位差8例; 2组患者的复位情况比较,差异无统计学意义(Z=-1.113,P=0.266)。结论:数字骨科技术辅助下行切开复位内固定术治疗跟骨骨折,可获得较好的骨折复位,而且能减少术中X线透视次数、缩短手术时间,值得临床推广应用。
Abstract:
Objective:To explore the applied value of digital orthopaedic technique in open reduction internal fixation(ORIF)for treatment of calcaneal fractures.Methods:Forty-four patients with calcaneal fracture enrolled in the study were randomly divided into digital technique group and conventional surgery group,22 cases in each group.Simulated ORIF were performed on patients in digital technique group before the surgery by using Mimics 15.0 software and calcaneal 3D printing model to determine type and location of the steel plate and location and length of the screws,and the steel plates were reshaped.During the surgery ORIF were performed in digital technique group according to the operation plan which was formulated on the basis of simulated surgery,while conventional ORIF were performed in conventional surgery group.The incision length,operative time,blood loss,frequency of intraoperative X-ray exposure,hospital stays and fracture reduction results were compared between the 2 groups.Results:The frequency of intraoperative X-ray exposure and operative time were less in digital technique group compared to conventional surgery group(7.4+/-3.6 vs 10.4+/-2.6,t=3.144,P=0.003; 51.0+/-7.7 vs 57.8+/-9.6 min,t=2.580,P=0.013).There was no statistical difference in the blood loss,incision length and hospital stays between the 2 groups(25.4+/-3.8 vs 26.6+/-4.3 ml,t=1.043,P=0.303; 12.4+/-1.3 vs 13.0+/-1.2 cm,t=1.831,P=0.074; 10.5+/-2.3 vs 10.4+/-1.7 days,t=0.226,P=0.823).According to Burwell-Charnley radiological evaluation standard,15 patients obtained anatomical reduction,3 fair and 4 poor in digital technique group; while 12 patients obtained anatomical reduction,2 fair and 8 poor in conventional surgery group.There was no statistical difference in the fracture reduction results between the 2 groups(Z=-1.113,P=0.266).Conclusion:In the treatment of calcaneal fractures,ORIF assisted by digital orthopaedic technique leads to better fracture reduction results,less intraoperative X-ray exposure and shorter operative time,so it is worthy of popularizing in clinic.

参考文献/References:

[1] Beaupre GS.Effect of fracture gap on stability of compression plate fixation:a finite element study[J].J Orthop Res,2011,29(1):152.
[2] 国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994:173.
[3] Burwell HN,Charnley AD.The treatment of displaced fractures at the ankle by rigid internal fixation and early joint movement[J].J Bone Joint Surg Br,1965,47(4):634-660.
[4] Bevill G,Keaveny TM.Trabecular bone strength predictions using finite element analysis of micro-scale images at limited spatial resolution[J].Bone,2009,44(4):579-584.
[5] 潘朝晖,王剑利,蒋萍萍,等.三种不同骨瓣重建跟骨缺损的有限元及临床分析[J].中华创伤骨科杂志,2005,7(6):529-532, 500. 中医正骨2015年12月第27卷第12期 J Trad Chin Orthop Trauma,2015,Vol.27,No.12(总903) (总904)中医正骨2015年12月第27卷第12期 J Trad Chin Orthop Trauma,2015,Vol.27,No.12
[6] Ochs BG,Gonser C,Shiozawa T,et al.Computer-assisted periacetabular screw placement: Comparison of different fluoroscopy-based navigation procedures with conventional technique[J].Injury,2010,41(12):1297-1305.
[7] Amin S,Kopperdhal DL,Melton LJ,et al.Association of hip strength estimates by finite-element analysis with fractures in women and men[J].J Bone Miner Res,2011,26(7):1593-1600.
[8] Bagaria V,Deshpande S,Rasalkar DD,et al.Use of rapid prototyping and three-dimensional Reconstruction modeling in the management of complex fractures[J].Eur J Radiol,2011,80(3):814-820.
[9] 郝东升,尹芸生,李栋,等.螺旋CT三维重建在跟骨骨折手术治疗中的价值[J].中国现代医学杂志,2006,16(23):3611-3614.
[10] 尹庆水,章莹,王成焘,等.临床数字骨科学——创新理论体系与临床应用[M].北京:人民军医出版社,2011:191.
[11] Yettram AL,Camilleri NN.The forces acting on the human calcaneus[J].J Biomed Eng,1993,15(1):46-50.
[12] Rübberdt A,Hofbauer VR,Herbort M,et al.3D navigated osteosynthesis of calcaneal fractures. Open and minimally invasive techniques[J].Unfallchirurg,2009,112(1):15-22.
[13] Kim KK,Heo YM,Won YY,et al.Navigation-assisted total knee arthroplasty for the knee retaining femoral intramedullary nail, and distal femoral plate and screws[J].Clin Orthop Surg,2011,3(1):77-80.
[14] Hung SS,Lee MY.Functional assessment of a surgical robot for reduction of lower limb fractures[J].Int J Med Robot,2010,6(4):413-421.
[15] Blumenfeld TJ,Bargar WL,et al.Surgical technique:a cup-in-cup technique to restore offset in severe protrusio acetabular defects[J].Clin Orthop Relat Res,2012,470(2):435-441.
[16] 温建民.跟骨骨折的治疗策略[J].中医正骨,2013,25(4):3-6.

相似文献/References:

[1]谭新欢,聂伟志,隋显玉,等.闭合复位经皮穿针内固定与切开复位接骨板内固定治疗 PaleyB1型跟骨骨折的对比研究[J].中医正骨,2015,27(12):16.
 TAN Xinhuan,NIE Weizhi,SUI Xianyu,et al.A retrospective trial of closed reduction and percutaneous internal fixation with Kirschner wire versus open reduction and internal fixation with bone plate for the treatment of Paley type B1 calcaneal fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(12):16.
[2]杨英果,王晓民,班兴平.内外侧联合弧形切口切开复位内固定治疗复杂跟骨骨折[J].中医正骨,2015,27(06):51.
[3]谭新欢,聂伟志,朱育林,等.跟骨骨折微创治疗的研究进展[J].中医正骨,2015,27(05):73.
[4]马献忠.分级分期治疗开放性跟骨骨折[J].中医正骨,2011,23(08):40.
[5]汤样华,曾林如,岳振双,等.跟骨后结节骨折内固定失败原因分析[J].中医正骨,2016,28(06):71.
[6]徐毅,李海勋,李智豪.跗骨窦切口微创接骨板内固定治疗SandersⅡ、Ⅲ型跟骨骨折[J].中医正骨,2016,28(08):41.
[7]高鹤梁.分期手术治疗跟骨创伤性骨髓炎[J].中医正骨,2016,28(10):55.
[8]齐兵,王振,姚小锐.三维截骨矫形距下关节融合锁定钛板内固定术治疗Stephens-SandersⅢ型陈旧性跟骨骨折畸形愈合[J].中医正骨,2016,28(11):56.
[9]李浩,沈永辉,季卫平.氦氖激光照射预防新鲜闭合性跟骨骨折术后切口并发症的临床观察[J].中医正骨,2016,28(11):59.
[10]陈先进,张军,张道平,等.撬拨复位双向空心螺钉内固定联合植骨治疗SandersⅡ、Ⅲ型跟骨骨折[J].中医正骨,2016,28(12):61.

备注/Memo

备注/Memo:
2015-09-06收稿 2015-10-29修回
更新日期/Last Update: 2015-12-30