CT Mimics三维重建解剖指标预测单纯掌侧钢板内固定术后背侧关节内骨块稳定性的研究  

A study on prediction of dorsal intra-articular bone fragment stability following simple volar plate internal fixation based on the anatomic indicators of CT Mimics three-dimensional reconstruction

作　　者：昌俊涛 刘晓波 高东芳 何晓浩 孙淑霞 CHANG Juntao;LIU Xiaobo;GAO Dongfang;HE Xiaohao;SUN Shuxia(Department of Radiology,Chongqing Jiulongpo Traditional Chinese Medicine Hospital,Chongqing 400050,China;Department of Orthopedics,Chonggang General Hospital,Chongqing 400080,China)

机构地区：[1]重庆市九龙坡区中医院放射科,重庆400050 [2]重钢总医院骨科,重庆400080

出　　处：《中国临床新医学》2025年第3期313-318,共6页CHINESE JOURNAL OF NEW CLINICAL MEDICINE

基　　金：2018年科卫联合中医药科技项目(编号:ZY201802090)。

摘　　要：目的探讨电子计算机断层扫描Materialise交互式医学图像控制系统(CT Mimics)三维重建解剖指标预测单纯掌侧钢板内固定术后背侧关节内骨块稳定性的价值。方法回顾性分析2021年9月至2023年6月重庆市九龙坡区中医院收治的165例行单纯掌侧钢板内固定术治疗桡骨远端骨折患者的临床资料。根据术后第2天及门诊随访(术后6个月)背侧关节内骨块移位情况将其分为移位组(30例,背侧关节内骨块移位>2 mm)和未移位组(135例,背侧关节内骨块移位≤2 mm)。比较两组一般资料及术前CT Mimics三维重建解剖指标水平,分析术前各解剖指标与术后背侧关节内骨块移位距离的相关性。采用多因素logistic回归分析影响术后背侧关节内骨块稳定性的因素,并基于筛得的指标构建列线图模型。采用受试者工作特征(ROC)曲线、校准曲线、决策分析曲线对列线图模型的应用价值进行评估。结果移位组骨折AO分型为C3型的人数比例高于未移位组,差异有统计学意义(P<0.05)。移位组骨块体积、骨块横纵比、骨块横向宽度小于未移位组,骨块术前总移位距离大于未移位组,差异有统计学意义(P<0.05)。骨块体积(r=-0.817,P<0.001)、骨块横纵比(r=-0.771,P<0.001)、骨块横向宽度(r=-0.843,P<0.001)与术后背侧关节内骨块移位距离呈负相关,骨块术前总移位距离与术后背侧关节内骨块移位距离呈正相关(r=0.746,P<0.001)。多因素logistic回归分析结果显示,骨折AO分型为C3型[OR(95%CI)=2.368(2.015~2.784)]、骨块术前总移位距离较大[OR(95%CI)=1.277(1.163~1.402)]是促进术后背侧关节内骨块移位的独立危险因素(P<0.05),较大的骨块体积[OR(95%CI)=0.464(0.268~0.802)]、骨块横纵比[OR(95%CI)=0.411(0.176~0.959)]、骨块横向宽度[OR(95%CI)=0.421(0.225~0.786)]是抑制术后背侧关节内骨块移位的独立保护因素(P<0.05)。基于骨折AO分型、术前CT Mimics三维重建解剖指标构建预测�Objective To explore the value of the prediction of dorsal intra-articular bone fragment stability following simple volar plate internal fixation based on the anatomic indicators of computed tomography(CT)Materialise′s interactive medical image control system(Mimics)three-dimensional reconstruction.Methods The clinical data of 165 patients with fractures of distal radius who were treated with simple volar plate internal fixation in Chongqing Jiulongpo Traditional Chinese Medicine Hospital from September 2021 to June 2023 were retrospectively analyzed.The patients were divided into a displacement group(30 cases,displaced dorsal intra-articular bone fragments>2 mm)and a non-displacement group(135 cases,displaced dorsal intra-articular bone fragments≤2 mm)according to the displaced dorsal intra-articular bone fragments on the 2nd day after surgery and during outpatient follow-up of 6 months after surgery.The general clinical data and the anatomic indicator levels of CT Mimics three-dimensional reconstruction before surgery were compared between the two groups,and the correlation between each preoperative anatomical indicator and the distance of the displaced dorsal intra-articular bone fragments was analyzed.Multivariate logistic regression analysis was used to analyze the factors affecting the stability of the dorsal intra-articular bone fragments after surgery,and a Nomogram model was constructed based on the screened indicators.The application value of the Nomogram model was evaluated by using receiver operating characteristic(ROC)curve,calibration curve,and decision-making analysis curve.Results The proportion of patients with fracture AO classification of C3 in the displacement group was higher than that in the non-displacement group,with statistically significant difference betweent the two groups(P<0.05).The volume,transverse to longitudinal diameter ratio,and transverse width of the bone fragments in the displacement group were smaller than those in the non-displacement group,while the total distance of

关 键 词：电子计算机断层扫描 Materialise交互式医学图像控制系统 解剖指标 桡骨骨折 掌侧内固定术 稳定性 预测 

分 类 号：R683.4[医药卫生—骨科学]