计算机三维仿真技术在复杂跟骨骨折手术中的应用  

COMPUTER AID DESIGNED OPERATION OF COMPLICATED CALCANEAL FRACTURE BY 3D SIMULATION TECHNIQUE

作　　者：章莹[1] 夏远军[1] 万磊[1] 吴文[1] 谭新宇[1] 谢会斌[1] 刘汉辉[1] 尹庆水[1] 

机构地区：[1]广州军区广州总医院骨科,广州510010

出　　处：《中国修复重建外科杂志》2009年第12期1447-1450,共4页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：广东省自然科学基金团队项目(20023001)~~

摘　　要：目的探讨将计算机三维仿真技术个体化设计应用于复杂跟骨骨折精确手术治疗的效果。方法2007年11月-2008年3月,收治38例跟骨关节内骨折患者。男29例,女9例;年龄14～69岁,平均29.8岁。Sanders分型:Ⅰ型4例,Ⅱ型14例,Ⅲ型12例,Ⅳ型8例。受伤至手术时间3h～5d。CT图像经计算机三维重建后测量健、患侧术前B?hler角,并行撬拨复位计算机三维设计,测量跟骨结节撬拨旋转角度。根据计算机测量骨折块旋转角度,为患者制定个体化手术方案,C臂X线机监测下行跟骨骨折切开复位内固定术。结果计算机测量术前健侧B?hler角为(34.58±4.38)°,患侧为(8.33±12.62)°,比较差异有统计学意义(P<0.05)。计算机模拟术中撬拨复位,骨折块旋转角度为(28.84±6.51)°,患侧B?hler角恢复至(32.86±1.72)°,与术前健侧比较差异无统计学意义(P>0.05),与术前患侧比较差异有统计学意义(P<0.05)。术后28例获随访,随访时间12～22个月,平均18个月。术后1年B?hler角恢复至(32.41±1.42)°。根据美国足踝外科学会足部功能评分系统评定,获优16例,良10例,中1例,差1例,优良率为92.9%。结论计算机三维仿真技术可个体化设计复杂跟骨骨折手术,术中精确恢复B?hler角及距下关节,是辅助治疗跟骨骨折的有效方法。Objective To precisely treat complicated calcaneal fracture by 3D simulation through computer aid designed operation. Methods From November 2007 to March 2008,38 patients of calcaneal fracture were treated. There were 29 males and 9 females aged 14-69 years old （average 29.8 years old）. According to Sanders classification,there were 4 patients of type I,14 of type II,12 of type III,and 8 of type IV. The time between injury and surgery was 3 hours to 5 days. The CT images of calcaneal fracture of 38 patients were put into computer for 3D reconstruction,then the Bhler angles were measured and bone grafting angles were designed. According to the angle surveyed by the computer,the individual-oriented operation program was made,and then the operation was done under C-arm X-ray machine. Results The preoperative Bhler angel was （34.58 ± 4.38）° in the normal side and （8.33 ± 12.62）° in the injured side,indicating there was significant difference （P 〈 0.05）. During the process of the poking reduction by 3D simulation,when the bone rotating angle was （28.84 ± 6.51）°,the Bhler angel was restored to （32.86 ± 1.72）°,indicating there was no significant difference when compared with the normal side before operation （P 〉 0.05）,and significant difference compared with the injured side before operation （P 〈 0.05）. Twenty-eight patients were followed up for 12-22 months （average 18 months）. The Bhler angel was restored to （32.41 ± 1.42）° 1 year after operation. According to the foot function scoring system made by American Ankle Surgery Association,16 cases were graded as excellent,10 as good,1 as fair,1 as poor,and the excellent and good rate was 92.9%. Conclusion Computer aid designed operation of complicated calcaneal fracture by 3D simulation technique can restore the Bhler angel and subtalar joint precisely. It is an effective supplementary treatment method for calcaneal fracture.

关 键 词：跟骨骨折 Bhler角 计算机三维仿真技术 撬拨复位 

分 类 号：R687.3[医药卫生—骨科学]