数字骨科技术在个体化Pilon骨折治疗中的应用价值与临床意义

Applied value and clinical significance of the digital orthopedics technology in the treatment of individualized Pilon fractures

关键词:  数字骨科技术  快速成型  Pilon骨折  内固定

Key words:  digital orthopedics technology  rapid prototyping  Pilon fractures  internal fixation

摘要:

目的　评价数字骨科技术在个体化Pilon骨折手术治疗中的应用价值与临床意义。方法　选取2012年1月至2016年5月收治的9例Pilon骨折患者，术前通过螺旋CT检查获取Pilon骨折患者的DICOM格式数据，而后利用Mimics17.0软件将其加工成数字模型，并进行Pilon骨折的诊断、分型和相关参数测量，最后依靠快速成型技术制作3D模型，辅助制定术前方案的同时模拟手术，指导手术治疗。观察骨折愈合时间、手术时间、Burwell-Charnley放射学标准评价系统、骨折分型和内固定（大小和位置）的准确率、Baird-Jackson踝关节功能评分及术后优良率等指标。结果　9例患者均获随访，随访时间为 (5.1±6.3) (1~15)个月。9例患者均顺利骨性愈合，平均愈合时间为(3.2±0.7)个月；平均手术时间为(1.0±0.3)h；Burwell-Charnley放射学标准8例患者解剖复位，1例患者功能复位；术前通过3D模型进行预弯的钢板与术中患者骨折表面完全贴合，骨折分型和内固定（大小、位置）的准确率均为100％；Baird-Jackson踝关节功能评分平均(84.6±9.0)分，术后优良率为88.9％。结论　数字骨科技术在Pilon骨折的正确诊断和个体化治疗中有着重要的潜在临床应用价值。

Abstract:

Objective To evaluate the applied value and clinical significance of digital orthopedics technology in the treatment of individualized Pilon fractures. Methods Nine patients with Pilon fractures as research objects were chosen from January 2012 to May 2016. The patients with Pilon fractures were examined by CT scan for acquiring DICOM format data, which was then made for the digital model of Pilon fractures with Mimics17.0. Proceeding the diagnosis, classification and related parameters measurement of Pilon fractures, the 3D model were printed by rapid printing technology, for making operative plan and simulating operation, and then guiding the surgical treatment. Clinical indicators, such as fracture healing time, operation time, Burwell-Charnley X-ray standard evaluation system, the accuracy rate of catagmatic classification and internal fixation (size and position), Baird-Jackson ankle function score and the excellent and good rate of postoperative, were evaluated for applied value and clinical significance of the digital orthopedics technology in terms of Pilon fracture individual treatment. Results The 9 cases were followed up with a mean period of (5.1±6.3) (1~15) months. Nine cases had already healed after operation; the average healing time was (3.2±0.7)months, the operative time was (1.0±0.3)h. According to Burwell-Charnley X-ray standard：anatomical replacement was 8, functional replacement was 1. The bending plates which were shaped on 3D model were suitable for the bone surface of Pilon fractures, the accuracy rate of catagmatic classification and internal fixation (size and position) was 100％. According to Baird-Jackson ankle function score, the score was (84.6±9.0), the excellent and good rate was 88.9%. Conclusion Digital orthopedics technology has important potential application value for correct diagnosis and individualized treatment of Pilon fractures.