计算机辅助与传统手术治疗老年C型桡骨远端骨折的对照研究  

Preoperative planning using computer-assisted virtual surgical technology versus conventional surgical methods for the treatment of elderly type-C distal radial fractures:a comparative study

作　　者：韩庆辉[1] 唐小莹 孙贵新[1] HAN Qing-hui;TANG Xiao-ying;SUN Gui-xin(Department of Orthopedic Trauma,East Hospital of Tongji University,Shanghai 200120,China)

机构地区：[1]同济大学附属东方医院创伤骨科,上海200120

出　　处：《创伤外科杂志》2020年第10期746-750,756,共6页Journal of Traumatic Surgery

基　　金：上海市浦东新区科技发展基金资助(2017PKJ-Y20)。

摘　　要：目的通过比较计算机辅助与传统手术治疗老年C型桡骨远端骨折,探讨计算机辅助手术治疗C型桡骨远端骨折的应用价值。方法回顾性分析2014年1月—2018年6月同济大学附属东方医院治疗的老年C型桡骨远端骨折患者56例,男性24例,女性32例;年龄60~83岁,平均68.7岁;道路交通伤25例,摔伤26例,高处坠落伤5例,均为闭合性骨折;按AO分型:C1型18例,C2型17例,C3型21例。2014年1月—2016年4月传统手术治疗31例(传统组),2016年5月—2018年6月计算机辅助手术治疗25例(计算机组)。计算机组与传统组患者术后平均随访分别为14.7个月与18.9个月。计算机组应用一站式计算机辅助术前计划(CAPP)系统进行精确的术前设计,实施个性化手术,传统组根据术前影像学分析行内固定手术。比较计算机组模拟复位后及术后影像学相关参数,两组手术时间、术中耗时、透视次数、远端螺钉背侧皮质穿出率、末次随访时影像学相关参数及Gartland-Werley腕关节评分。结果计算机组各参数在模拟复位后与术后相比较,平均桡骨高度[(12.03±4.28)mm vs.(11.12±3.15)mm]、下尺桡关节面台阶[(0.56±0.12)mm vs.(0.61±0.13)mm]、掌倾角[(12.40±4.56)°vs.(11.24±4.27)°]、尺偏角[(23.46±3.26)°vs.(22.28±4.32)°],差异均无统计学意义(P>0.05)。计算机组与传统组平均术中耗时[(62.37±3.78)min vs.(93.43±6.56)min]、透视次数[(4.02±0.15)次vs.(8.06±0.89)次]、远端螺钉背侧皮质穿出率(0 vs.35.5%)、末次随访时桡骨高度[(12.04±4.36)mm vs.(10.05±3.28)mm]和掌倾角[(11.45±4.63)°vs.(8.26±2.49)°]比较,差异均有统计学意义(P<0.05);计算机组与传统组患者末次随访时尺偏角[(23.64±3.36)°vs.(22.86±3.48)°]、下尺桡关节面台阶[(0.32±0.18)mm vs.(0.46±0.25)mm]及Gartland-Werley腕关节评分优良率(92.0%vs.83.9%)比较,差异均无统计学意义(P>0.05)。计算机组中有6例(24.0%)手术入路和(或)关键骨折块的复位顺序发Objective To investigate whether preoperative planning using computer-assisted virtual surgical technology was superior to conventional methods for the treatment of elderly type-C distal radial fractures.Methods The data of elder patients with type-C distal radial fractures between Jan.2014 and Jun.2018 were retrospectively analyzed.Among the 56 patients,the mean age(range)was 68.7(60-83)years;32 patients were women;and they were all closed fracture(traffic injury,25 patients;falling injury,26 patients;and high falling injury,5 patients).According to AO classification,there were 18 cases of type C1,17 cases of type C2,and 21 cases of type C3.Of those patients,25 patients received computer-assisted virtual preoperative planning(from May 2016 to Jun.2018),and 31 patients received conventional preoperative planning(from Jan.2014 to Apr.2016).The mean follow-up period was 14.7 months for computer-assisted planning and 18.9 months for conventional planning.The intraoperative implementation of preoperative planning based on computer-assisted virtual technology was evaluated using radiographic parameters.Operation time,intraoperative time,times of fluoroscopy,and rate of distal screw dorsal cortex penetration were compared.Radiographic parameters and Gartland-Werley score were recorded at the last follow-up.Results For patients with computer-assisted virtual preoperative planning,no substantial difference was observed between preoperative simulated reduction and postoperative situation in terms of radial height[(12.03±4.28)mm vs.(11.12±3.15)mm],step of the lower ulnar radial joint surface[(0.56±0.12)mm vs.(0.61±0.13)mm],palmar angle[(12.40±4.56)°vs.(11.24±4.27)°],and ulnar angle[(23.46±3.26)°vs.(22.28±4.32)°].In virtual surgical group,the mean intraoperative time was(62.37±3.78)minutes;the mean times of fluoroscopy was 4.02±0.15;the penetration rate of the dorsal cortex of distal screws was 0;the mean radial height was(12.04±4.36)mm;and the mean palmar inclination was(11.45±4.63)°.In conventional group,

关 键 词：桡骨骨折 计算机辅助 内固定 老年 

分 类 号：R683.41[医药卫生—骨科学]