跗骨窦切口联合个性化手术导板在SandersⅡ、Ⅲ型跟骨骨折术中的应用  

The Application of the Combined Individualized Surgical Guide of Tarsal Sinus Incision in the Operation of Sanders Ⅱ and Ⅲ Calcaneus Fracture

作　　者：沈美华 施凯兵 施晓健[2] 张红 沈灵杰 杨伽捷 SHEN Mei-hua;SHI Kai-bing;SHI Xiao-jian(Vice-president of Haimen People＇s Hospital, Haimen 226100, Jiangsu Province, P.R.C.)

机构地区：[1]海门市人民医院手足外科 [2]海门市人民医院

出　　处：《中国数字医学》2018年第6期76-78,89,共4页China Digital Medicine

基　　金：海门市科技计划资助项目(编号:2016YW02)~~

摘　　要：目的:探讨跗骨窦切口联合个性化手术导板在跟骨骨折术中的应用。方法:选择Sanders Ⅱ、Ⅲ型跟骨骨折患者,术前分别对患者行跟骨CT扫描,跗骨窦切口组通过传统经验,复位关节,固定跟骨。数字骨科组在跗骨窦切口的基础上,预先设计并打印手术导板,术中根据导管的位置置入空心螺钉,再在跗骨窦切口内置入已选定的钢板。结果:数字骨科组的术中X线透视次数和手术时间均少于跗骨窦切口组,组间差异均有统计学意义。两组患者的出血量、住院时间、Gissane角和Bohler角比较,差异均无统计学意义(P>0.05);数字骨科组术后AOFAS评分优良率优于跗骨窦切口组(P<0.05)。两组并发症发生率比较,差异有统计学意义。结论:跗骨窦切口联合个性化手术导板在Sanders Ⅱ、Ⅲ型跟骨骨折的术前判断、临床诊治方式的选择等方面提供了更为精准的解剖学及影像学依据。Objective： To explore the application of individualized surgical guiding templates with tarsal sinus incision in calcaneal fracture. Methods： Patients with Sanders Ⅱ and Sanders Ⅲ calcaneal fractures were selected. CT scan was performed on the calcaneus before operation. The group of tarsal sinus incision was restored to the joints and fixed calcaneus through traditional experience. On the basis of the tarsal sinus incision, the digital department of orthopedics group predesigned and printed the surgical guide plate, and placed hollow screws according to the location of the catheter, and then inserted the selected steel plates in the tarsal sinus incision. Results： The number of X-ray fluoroscopy and operation time in the digital orthopedics group were less than the tarsal sinus incision group, and the difference between the two groups was statistically significant. Two groups of patients with bleeding, hospitalization time, Gissane angle and Bohler angle, there were no significant differences（P〉0.05）; Digital orthopedics group the postoperative AOFAS scores were superior to the tarsal sinus incision group（P〈0.05）. The complication rate of the two groups was compared, the difference was statistically significant. Conclusion： The combination of the tarsal sinus incision and the individualized surgical guide provides more accurate anatomic and imaging basis for the preoperative judgement of Sanders Ⅱ and Ⅲ calcaneal fractures and the choice of clinical diagnosis and treatment methods.

关 键 词：螺旋CT 3D打印 三维重建 跟骨骨折 

分 类 号：R683.42[医药卫生—骨科学] R445.1[医药卫生—外科学]