数字骨科技术在肱骨近端锁定钢板治疗肱骨近端骨折中的应用  

The application of computer simulation in the treatment of proximal humeral fractures with PHILOS

作　　者：陆新颜[1] 陈刚[1] 廉凯[1] 吴农欣[1] 

机构地区：[1]湖北文理学院附属医院襄阳市中心医院骨科,湖北襄阳441021

出　　处：《中华手外科杂志》2014年第4期259-261,共3页Chinese Journal of Hand Surgery

摘　　要：目的 应用数字骨科技术探讨肱骨近端锁定钢板（PHILOS）治疗肱骨近端骨折失败的因素.方法 回顾分析我院47例肱骨近端骨折患者,患者术前均做三维CT重建,利用计算机模拟软件分析肱骨内侧壁是否完整,肱骨头松质骨密度及分布,模拟安置的肱骨近端锁定加压钢板（LCP）螺钉同肱骨头骨骨质的把持关系.根据以上指标分为骨质正常组（A组）和骨质疏松组（B组）,记录两组患者的骨折复位维持情况,对内固定物失效情况进行比较.结果 骨质异常组术后骨折复位维持情况及内固定失效情况高于骨质正常组.结论 对于骨折疏松合并内侧壁缺失的患者,肱骨近端锁定钢板同样存在内固定失效的风险.内侧植骨可以减少失效的发生.Objective To explore the reasons of failure in the treatment of proximal humerus fractures by PHILOS using computer simulation.Methods A retrospective review of 47 cases of proximal humerus fractures was conducted.Preoperative spiral CT scanning was obtained in all the patients for 3D reconstruction to determine whether the medial cortical support was intact.Cancelous bone density of the humeral head and its distribution were analyzed.Simulation of fracture reduction and internal fixation with locking compression plate were carried out in MIMICS.The patients were divided into 2 groups：group A （normal） and group B （with osteoporosis and lack of medial cortical support）.Maintenance of reduction and failure of the internal fixation were compared between the two groups.Results The failure rate of PHILOS in group B was significantly higher than that of group A.Conclusion There are potential risks in the treatment of proximal humerus fractures by PHILOS in cases with osteoporosis and lack of medial cortical support.Medial side bone graft can decrease failure rate.

关 键 词：计算机模拟 肱骨骨折 近端 肱骨近端锁定钢板 

分 类 号：R687.3[医药卫生—骨科学]