虚拟三维重建术前规划技术在Pilon骨折的应用研究  

PRELIMINARY APPLICATION OF VIRTUAL PREOPERATIVE RECONSTRUCTION PLANNING IN Pilon FRACTURES

作　　者：王小平[1] 韦展图[1] 黄俭[1] 陈路遥[1] 胡世锵[1] 吴玮伟[1] 屠玉民[1] 郭胜[2] 许国泰[2] 邓志成[2] 

机构地区：[1]南方医科大学附属小榄医院创伤脊柱外科,广东中山528415 [2]南方医科大学附属小榄医院创伤关节外科,广东中山528415

出　　处：《中国修复重建外科杂志》2016年第1期44-49,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：广东省中山市科技计划基金项目(20113A014)~~

摘　　要：目的探讨虚拟三维重建术前规划技术在Pilon骨折治疗中的应用价值。方法 2010年7月-2014年6月,收治16例Pilon骨折患者。其中男12例,女4例;年龄22~53岁,平均36.5岁。骨折按国际内固定研究学会/美国矫形创伤学会（AO/OTA）分型：43.B2型2例,43.B3型3例,43.C1型3例,43.C2型2例,43.C3型6例。受伤至手术时间6~14 d,平均10.2 d。术前将患者CT图像数据集导入Mimics10.01软件,建立复杂胫骨Pilon骨折三维数字化模型,对骨折块进行复位、植入内固定等虚拟手术,初步建立Pilon骨折手术的术前规划系统,并按此术前规划指导实施手术治疗。结果重建的Pilon骨折三维数字化模型可准确反映骨折特点,辅助术者准确对骨折分型;虚拟手术可逼真模拟临床手术,辅助术者在术前规划时实现多方案的直观呈现和分享。手术时间70~130 min,平均87.8 min;术中失血量30~150 m L,平均71.9 m L。术后患者切口均Ⅰ期愈合。16例均获随访,随访时间8~18个月,平均11.6个月。术后3 d根据Burwell-Charnley影像学评价标准判定骨折复位质量,16例关节面均获解剖复位,无内固定物进入关节腔内。X线片复查示骨折均于术后3~6个月愈合,平均3.7个月。随访期间无内固定物松动、断裂等并发症发生。末次随访时,踝关节功能按AOFAS踝与后足评分标准评价,为71~100分,平均92.3分;获优10例,良5例,可1例,优良率93.8%。末次随访时X线片示骨折复位无丢失。结论虚拟三维重建术前规划技术应用于Pilon骨折治疗,临床可行性良好,有利于术者术前对Pilon骨折进行深入理解和制定手术计划。Objective To investigate the application value of three-dimensional reconstruction and virtual preoperative planning for Pilon fractures. Methods Between July 2010 and June 2014, 16 patients with closed Pilon fracture were treated, including 12 males and 4 females with an average age of 36.5 years（range, 22-53 years） and a mean disease duration of 10.2 days（range, 6-14 days）. According to AO/Orthopaedic Trauma Association（AO/OTA） typing, 2 cases were rated as 43.B2 type, 3 cases as 43.B3 type, 3 cases as 43.C1 type, 2 cases as 43.C2 type, and 6 cases as 43.C3 type. The preoperative CT data from 16 patients were imported into Mimics10.01 software to establish the detailed fracture threedimensional digital models. Virtual operation of fracture reduction and implanting internal fixation was performed on the models, and the optional surgical planning was made. Based on the virtual preoperative planning, operations were performed. Results Established detailed three-dimensional Pilon fracture digital models could perfectly reflect the fracture characteristics, could be observed at any direction, and aided for fracture classification accurately. Virtual fracture operations of reduction, internal fixation and other could be performed to simulate the clinical operation, which could assist the surgeon better preoperative planning in achieving visual presentation and improving the communication. The operation time was 70-130 minutes（mean, 87.8 minutes）; intraoperative blood loss volume was 30-150 m L（mean, 71.9 m L）. The wounds healed by first intension in all patients. The mean follow-up time was 11.6 months（range, 8-18 months）. Postoperative radiological results at 3 groups showed good anatomic reduction according to the BurwellCharnley criteria, and the fracture healing time was 3-6 months（mean, 3.7 months）. There was no complication of internal fixation loosening or breakage during follow-up. The American Orthopedic Foot and Ankle Society（AOFAS） score was 71-100（mean, 92.3）; the resul

关 键 词：MIMICS软件 PILON骨折 术前三维重建 虚拟手术规划 

分 类 号：R687.3[医药卫生—骨科学]