计算机辅助设计应用于Taylor外固定支架行长骨骨折复位的效果  

The application of computer-assisted design in the reduction of long bone fractures with Taylorspatial frame

作　　者：张兴鹏 刘彦士 马信龙[1] 孙振辉[1] 汪松 李红 张弢[1] Zhang Xingpeng;Liu Yanshi;Ma Xinlong;Sun Zhenhui;Wang Song;Li Hong;ZhangTao(Department of Orthopedic Trauma,Tianfin Hospital,Tianjin 300211,China)

机构地区：[1]天津医院创伤骨科,300211 [2]徐州医科大学附属医院

出　　处：《中华外科杂志》2018年第10期786-792,共7页Chinese Journal of Surgery

基　　金：天津市卫生和计划生育委员会科技基金攻关项目（16KG139）,国家自然科学基金（51775367）

摘　　要：目的探讨基于三维重建技术的计算机辅助设计法应用于Taylor外固定支架行胫腓骨骨折复位的效果。方法回顾性分析2016年1月至2018年1月天津医院创伤骨科采用Taylor外固定支架治疗的69例胫腓骨骨折病例资料，比较采用计算机辅助设计法（实验组）和采用配套软件标准测量法（对照组）行骨折复位的患者术后的残余畸形量的差异。所有患者在术后拍摄患肢的正、侧位胫腓骨全长x线片，实验组的患者行双侧胫腓骨CT断层扫描。将DICOM格式文件导入Mimics17．1软件中进行骨段及外固定环的三维模型重建，将此模型与标准环模型及患肢与健侧镜像进行视觉匹配，对骨块断端进行复位轨迹规划，获得复位后的外固定环位置。输出STL文件导入SolidWorks软件进行测量，得出6根杆的长度，通过调节6根螺杆进行复位。对照组使用CoreldrawX7软件测量患者x线片中的相关参数并输入Taylor外固定支架系统配套软件，根据软件出具的处方调节6根带刻度的螺杆进行复位。复位后所有患者拍摄患侧胫、腓骨全长标准正侧位x线片，与复位前的x线片对比，评估残余畸形量的改善程度。非正态分布的计量资料以M（QR）表示，组间比较采用非参数检验。结果69例患者均获得较好的骨折复位，达到功能复位标准。实验组患者正、侧位片中的位移、角度残余畸形量（改善度）分别为0．50（2．30）nlm（90．0％）、0．00（0．85）ITlm（100％）；0．00°（1．50°）（100％）、0．00°（0．00°）（100％）。对照组患者正、侧位片中的位移和角度残余畸形量（改善度）分别为1．40（3．28）mm（68．5％）、2．15（4．27）mm（46．3％）和1．15°（1．85°）（72．9％）、0．80°（2.10°）（66．7％）。实验组与对照组的残余畸形量相比，远折段前后移长度（Z=-3．865，P=0．000）、远折段内外翻角度（z=-2．0Objective To evaluate the effect of computer-assisted design based on three- dimensional reconstruction technique on the reduction accuracy of tibia1 and fibular fractures with Taylor external fixation. Methods A retrospective review was conducted on the clinical data of 69 patients who had tibia and fibula fractures treated with Taylor external fixation in department of orthopedic trauma of Tianjin Hospital from January 2016 to January 2018 to compare the residual deformity after fracture reduction between computer-assisted design method （experimental group ） and the standard measurement method （control group）. The frontal and lateral tibia and fibula X-ray of all the affected limbs were taken. In experimental group, all the patients took bilateral tibial CT tomography, and then DICOM format documents were input into the Mimics 17.1 software and got three-dimensional models of targeted bone and external fixation ring. After that the visual image matching was performed between external fixation ring three- dimensional reconstruction model and the standard model and also between the affected limb and the eontralateral limb. Then the reduction trajectory plan of bone broken end and the position of external fixation ring were obtained. The STL files were input to Solid Works software and got the length of six rods to adjust the Taylor external fixation. In control group, the films were measured by Coreldraw X7 X-ray measurement software and the parameters were input in Taylor Spatial Frame system software. And then six calibrated threaded rods were adjusted according to the prescription of the software. Finally, all the patients took the X-ray films again to evaluate the degree of residual displacement. Skew distributional data are indicated with M（ QR ） , and method of non-parameter was used to analyze variances between groups. Results All patients had better fracture reduction and achieved functional reset criteria. In the control group, the amount of displacement and angle residual aberration （impro

关 键 词：骨折 计算机辅助设计 Taylor外固定支架 三维重建 

分 类 号：R687.3[医药卫生—骨科学]