个性化髓内螺钉内固定治疗Jones骨折的疗效分析  

Effectiveness of personalized intramedullary screw internal fixation for treatment of Jones fracture

作　　者：汪海清[1] 曹乐[2] 黄雷[1] 许文博[1] 张峰[1] 朱大东 申成春[1] 任昊旸 姚陆丰[1] WANG Haiqing;CAO Le;HUANG Lei;XU Wenbo;ZHANG Feng;ZHU Dadong;SHEN Chengchun;REN Haoyang;YAO(Department of Foot and Ankle Surgery,NingboNo.6 Hospital,Ningbo,Zhejiang 315040,China)

机构地区：[1]宁波市第六医院足踝外科,浙江315040 [2]浙江大学医学院附属第二医院骨科,浙江杭州310009 [3]宁波市奉化新桥骨科医院足踝外科,浙江315500

出　　处：《中国骨与关节损伤杂志》2024年第6期610-614,共5页Chinese Journal of Bone and Joint Injury

基　　金：宁波市自然科学基金项目(2021J022);浙江省医药卫生科技项目(2021KY329);宁波市鄞州区科技项目(2020AS073);国家自然科学基金(32060139);宁波市奉化区科技项目(202106415)。

摘　　要：目的观察个性化髓内钉内固定治疗Jones骨折的临床疗效。方法回顾性分析自2019-07-2022-12采用个性化髓内钉内固定治疗的6例Jones骨折,术前将患者CT数据导入Mimics 15.0软件进行三维重建,然后进行个性化术前设计、模拟置钉,指导术中精确髓内钉固定。术后随访记录患者疼痛VAS评分、骨性愈合时间、患足提踵时间、患者恢复伤前运动水平时间。结果本组均获得随访,随访时间10~18个月,平均14个月。1例切口周围轻微麻木不适,口服营养神经药物1个月后好转,其余患者均无并发症发生。所有患者均于术后3个月获得骨性愈合,患足恢复提踵时间平均5.3(5~6)个月。患者恢复伤前运动水平时间平均6.8(6~8)个月。末次随访时疼痛VAS评分由术前平均7(6~8)分降至平均1(0~2)分。结论个性化髓内螺钉内固定治疗Jones骨折的疗效满意,术前采用Mimics软件设计并测量个性化最佳钉道指导术中髓内钉置钉,可增加置钉精确度,降低因置钉不准、螺钉尺寸不适、进针点定位不良而导致的骨折端分离移位、骨折不愈合或延迟愈合、再发骨折等并发症发生率。Objective To observe the clinical effect of personalized intramedullary screw internal fixation for treatment of Jones fracture.Methods Six cases of Jones fracture treated with personalized intramedullary screw internal fixation from July 2019 to December 2022 were retrospectively analyzed.The patients'CT data were imported into the Mimics 15.0 software for threedimension reconstruction before operation,and preoperative personalized design and simulation of the screw placement were performed to guide the intraoperative screw placing accurately.The Visual Analog Scale(VAS)scores,the time of fracture bony healing,and the time of heel lifting,and the time of recovering to the sports level before injury were recorded during the followup.Results All patients were followed up,the time of follow-up were 10-18 months,mean 14 months.One patient suffered numbness around the incision,and improved with oral neurotrophic drugs for 1 month.No complications occurred in other patients.The fracture healed after 3 months for all patients and the time of heel lfting was mean 5.3 months(range,5-6 months).The time of recovering to the sports level before injury was mean 6.8 months(range,6-8 months).The VAS score of the patients at the last follow-up decreased from 7 points(range,6-8 points)preoperative to 1 points(range,O-2 points).Conclusion Personalized intramedullary screw internal fixation for treatment of Jones fracture showed a satisfactory outcome.The personalized optimal screw trajectory is designed and measured with Mimics software preoperatively to guide the intramedullary screw placing intraoperatively,which could increase the accuracy of screw placement and reduce the incidence of complications such as re-fracture and the fracture sites displacement and nonunion or delayed union caused by the screw placement inaccuracy,the inappropriate screw size and the inaccurate insertion point.

关 键 词：JONES骨折 跖骨 髓内钉 计算机模拟 骨折固定术 

分 类 号：R687.3[医药卫生—骨科学]