摘要
目的探讨计算机辅助术前计划在踝关节骨折手术中的应用价值。方法 2012年1月-2014年1月,收治42例踝关节骨折患者。男22例,女20例;年龄19~72岁,平均52岁。致伤原因:扭伤20例,交通事故伤14例,高处坠落伤8例。受伤至手术时间5 h^12 d,平均2.5 d。均为闭合性三踝骨折;根据Lauge-Hansen分型标准:旋后外旋型Ⅳ度25例,旋前外旋型Ⅳ度13例,旋前外展型Ⅲ度4例。行切开复位钢板螺钉内固定术前,利用Superimage虚拟手术软件行虚拟复位及内固定操作,制定手术计划。结果手术时间为76~120 min,平均93.7 min。术后1例发生外踝切口裂开,经处理后Ⅱ期愈合;其余切口均Ⅰ期愈合。术后X线片及CT复查显示,踝关节骨折获解剖复位,内固定物位置满意。患者均获随访,随访时间9~27个月,平均14.6个月。术后6~8周患侧踝关节活动度达到或接近健侧;骨折愈合时间为11~17周,平均13.1周。末次随访时,X线片示3例(7.1%)踝关节有退行性改变;根据Baird-Jackson踝关节评分系统评定,获优24例,良13例,可5例,优良率88%。结论计算机辅助术前设计有利于术前明确骨折类型及完善手术方案,能指导骨折复位、内固定物的选择及植入,从而获得满意临床疗效。
Objective To explore the clinical value of computer-assisted surgical planning in the treatment of ankle fractures. Methods Between January 2012 and January 2014, open reduction and internal fixation were performed on 42 patients with ankle fractures. There were 22 males and 20 females with an average age of 52 years （range, 19-72 years）. The causes were spraining injury （20 cases）, traffic accident injury （14 cases）, and falling from height injury （8 cases）. The time from injury to operation was 5 hours to 12 days （mean, 2.5 days）. All fractures were dosed trimalleolar fractures. According to Lauge-Hansen classification, 25 cases were rated as supination extorsion type IV, 13 as pronation extorsion type IV, and 4 as pronation abduction type III. The preoperative planning was made by virtual reduction and internal fixation using Superimage software. Results The mean operation time was 93.7 minutes （range, 76-120 minutes）. Delayed wound healing occurred in 1 case, and secondary healing was obtained after treatment; primary healing of incision was achieved in the other patients. Postoperative X-ray films and CT images showed anatomic reduction of fracture and good position of internal fixation. All patients were followed up 14.6 months on average （range, 9-27 months）. The range of motion of the affected ankle was close to the normal side at 6-8 weeks. The mean fracture healing time was 13.1 weeks （range, 11-17 weeks）. Degenerative change of the ankle joint was observed in 3 cases （7.1%） with manifestation of mild narrowing of joint space on the X-ray films at last follow-up. According to Baird-Jackson score system, the results were excellent in 24 cases, good in 13 cases, and fair in 5 cases, with an excellent and good rate of 88%. Conclusion Computer-assisted surgical planning for ankle fractures can help surgeons identify type of ankle fractures and improve surgical scheme for guiding fracture reduction and selecting and placing implants, so good effectiveness can be obtained.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2015年第12期1469-1473,共5页
Chinese Journal of Reparative and Reconstructive Surgery
基金
上海市浦东新区卫生系统学科带头人培养计划资助项目(PWRD2011-07)
上海市浦东新区卫生和计划生育委员会科技发展专项基金资助项目(PW2014A-46)~~
关键词
踝关节骨折
计算机辅助软件
术前设计
内固定
Ankle fracture
Computer-aided software
Preoperartive planning
Internal fixation
