数字化设计精准治疗多发肋骨骨折的临床应用价值  

The clinical application value of digital precise design treatment for multiple rib fractures

作　　者：张才铭[1] 高晓盈 吴祖培[1] 蒋志坚[1] 陈宇宁[1] 黄健东 周路路 Zhang Caimin;Gao Xiaoying;Wu Zupei;Jiang Zhijian;Chen Yuning;Huang Jiandong;Zhou Lulu(Department of Surgery,Shunde Hospital of Guangzhou University of Chinese Medicine,Foshan 528300,China;Shantou University Medical College,Shantou 515041,China;Cancer Hospital of Shantou University Medical College,Shantou 515031,China)

机构地区：[1]广州中医药大学顺德医院外二科,佛山528300 [2]汕头大学医学院,515041 [3]汕头大学医学院附属肿瘤医院,515031

出　　处：《国际医药卫生导报》2018年第15期2265-2271,共7页International Medicine and Health Guidance News

基　　金：广东省佛山市科技计划项目（2017AB003743）

摘　　要：目的探讨数字化设计精准治疗多发肋骨骨折的临床应用价值。方法对20例多发肋骨骨折患者，根据cT资料进行皮肤和肋骨三维重建；在皮肤可视化状态下定位肋骨骨折，设计手术切口；计算机虚拟复位后，测量骨折处的高度和弯曲度，选择合适的肋骨接骨器，并进行虚拟内固定术。最后，根据以上数据进行手术治疗。结果1．三维重建结果：均获得了清晰的立体解剖结构及可视化3D图像模型。2．数字化设计结果：20例患者总共77处肋骨骨折，数字化设计与传统方法进行比较，采用数字化设计定位肋骨骨折更精准（P=0．001），手术更做创；虚拟复位均达到解剖复位要求，接骨器的高度及弯曲度完全符合目标肋骨的要求（P=0．001），固定良好。3．随访1-6个月，接骨器均无上翘、移位、滑脱。结论数字医学技术有助于充分了解多发肋骨骨折的立体解剖结构，有助于术中精准定位及肋骨接骨器的最优选择，具有精准化、做创化、个性化、安全性等优点，是治疗多发肋骨骨折的一种理想方法。Objective To study the clinical application value of digital precise design treatment for multiple rib fractures. Methods For 20 patients with multiple rib fractures, the skin and ribs were three- dimensionally reconstructed according to CT data. The rib fractures were accurately positioned and surgical incision of rib fractures was designed under the visualization state. Computer virtually reseted rib fractures, measured the height and curvature of the fracture, selected the appropriate bone connector, and performed the virtual internal fixation. Finally, according to the digital design scheme, internal fixation was performed. Results 1. 3D reconstruction result： clear anatomical structure and visual 3D image model were obtained. 2. Digital design result： for 77 fractured ribs of 20 patients, compared digital design with traditional method （combined the CT and doctor experience）, digital design positioning fractured ribs were more accurate （P=0.001）, incision more minimally invasive; the simulation reposition met the mmtomical request, the height and curvature of the rib connectors accorded with those of the ribs （P=0.001）, which jointted closely and simulation fixed well. 3. The bone connectors had no upwaxp, displacement, or slippage during follow up for one month to six months. Conclusions Digital medical technology contributes to fully understanding the three-dimensional structure of multiple rib fractures. The preoperative digital design is helpful to the accurate positioning of the operation and the optimal choice of rib bone connectors. With the advantages of precision, minimal invasion, individuation, and safety, it is an ideal method for the treatment of multiple rib fractures.

关 键 词：肋骨骨折 数字医学 三维重建 精准医学 内固定 肋骨接骨器 

分 类 号：R687.3[医药卫生—骨科学]