四维壁厚分析法在判断股骨骨愈合程度中的应用  

Four-dimensional analysis of wall thickness for judgment of femoral bone healing

作　　者：童梁成 薛庆 杨智伟 袁新平 许建辉 李颖 Tong Liangcheng;Xue Qing;Yang Zhiwei;Yuan Xinping;Xu Jianhui;Li Ying(Department of Orthopaedics,Air Force Hospital of Eastern Military Theater of PL4,Nanjing 2 J0002,China;Department of Radiology,Air Force Hospital of Eastern Military Theater of PLA,Nanjing 210002,China;Three Tribes(Shanghai)Technology Co.,Ltd.Shanghai 200230,China)

机构地区：[1]解放军东部战区空军医院骨科,南京210002 [2]解放军东部战区空军医院医学影像科,南京210002 [3]三的部落(上海)科技股份有限公司,上海200230

出　　处：《中华创伤骨科杂志》2020年第9期746-752,共7页Chinese Journal of Orthopaedic Trauma

基　　金：南京军区医学科技创新项目(15DX012);南京市医学科技发展项目(201503008)。

摘　　要：目的探讨四维壁厚分析法判断股骨骨愈合程度的可行性和有效性。方法回顾性分析解放军东部战区空军医院骨科2014年6月至2019年6月期间临床诊断为股骨骨愈合不良及骨不连的29例患者资料。男24例,女5例;平均年龄为41.8岁(5~54岁)。骨延迟愈合25例,骨不连4例(肥大型2例,萎缩型2例)。复查患者CT资料,采用Mimics 2.0软件,利用四维壁厚分析法对股骨骨愈合不良及骨不连患者在骨愈合不同阶段的CT数据进行三维模拟仿真计算,通过与健侧肢体相同部位进行对比分析,判断骨折段的骨愈合程度,结合时间的变化规律,辅助诊断股骨骨愈合、骨延迟愈合和骨不连。对临床诊断进行二次修正,并观察最终的临床愈合结果。结果所有患者术后获1~4年(平均14.9个月)随访。29例患者临床诊断:骨愈合13例(44.8%),骨延迟愈合12例(41.4%),骨不连4例(13.8%)。经四维壁厚分析法修正诊断:骨愈合9例(31.0%),骨延迟愈合18例(62.1%),骨不连2例(6.9%)。两种方法判断结果比较差异有统计学意义(χ2=15.399,P=0.031)。结论四维壁厚分析法判断股骨骨愈合程度是可行的,可以定量分析骨愈合的程度,为骨不连和骨延迟愈合的临床诊断提供一个相对客观的诊断依据。Objective To explore the feasibility and effectiveness of four-dimensional analysis of wall thickness for judgment of femoral bone healing.Methods The clinical data were retrospectively analyzed of the 29 patients who had been diagnosed with femoral bone malunion or bone nonunion at Department of Orthopaedics,Air Force Hospital of Eastern Military Theater of PLA from June 2014 to June 2019.They were 24 males and 5 females with an average age of 41.8 years(from 5 to 54 years).There were 25 cases of delayed union and 4 cases of nonunion(including 2 ones of hypertrophic nonunion and 2 ones of at-rophic nonunion).Mimics software 2.0 and the four-dimensional analysis of wall thickness were used to simulate and analyze the fracture bone healing of the patients at different time points.In comparison with the CT data of the contralateral healthy limb,the fracture bone healing was judged to assist the diagnosis of femoral union,delayed union and nonunion on the basis of the changing trends with time.The original clinical diagnoses were thus revised and the eventual clinical healing outcomes were observed.Results All the patients were followed up for 1 to 4 years(mean,14.9 months).Of them,bone union was clinically diagnosed in 13(44.8%),delayed bone union in 12(41.4%)and bone nonunion in 4(13.8%).According to the judgment by four-dimensional analysis of wall thickness,the clinical diagnoses were modified as follows:9 cases(31.0%)had bone union,18 cases(62.1%)delayed bone union,and 2 cases(6.9%)bone nonunion.There were statistically significant differences between the 2 methods(χ2=15.399,P=0.031).Conclusions The four-dimensional analysis of wall thickness can be used to analyze quantitatively the femoral bone healing,providing a relatively objective basis for clinical diagnosis of bone nonunion and delayed bone union.

关 键 词：骨折愈合 骨延迟愈合 骨折 不愈合 四维壁厚分析法 

分 类 号：R683[医药卫生—骨科学]