CAJ | 학술논문

目的探讨术前数字化设计是否可以提高成人股骨远端C1型骨折钢板内固定的效果.方法取10对左、右同源的成人股骨湿性标本,制作股骨远端C1型骨折模型,行CT扫描并将数据导入Mimics 14.0软江.右侧为实验组(10具):进行骨折三维模型重建、三维编辑、虚拟内固定物置入及测量等术前数字化设计,以设计参数指导实际内固定操作.左侧为对照组(10具):按常规骨折手术原则直接行内固定物置入.评价指标:①虚拟和实际内固定置入相似度评分(满分为10分),②实验组和对照组内固定后的优劣程度(骨折复位满意度、钢板挑选的合理性、钢板的服贴程度及螺钉置入位置),③生物力学压缩实验,④内固定操作时间.结果实验组虚拟和实际内固定的相似度评分平均为9.7分.实验组的骨折复位满意度、钢板挑选的合理性、钢板的服贴程度、螺钉置入位置、最大载荷及断裂载荷均优于对照组,差异有统计学意义(P＜0.05).实验组内固定操作时间[(32.5±3.2)min]短于对照组[(39.1±2.3)min],但总手术时间(术前设计时间+内固定操作时间)[(81.9±10.0)min]长于对照组[(39.1±2.3)min],差异均有统计学意义(P＜0.05).结论术前数字化设计可使成人股骨远端C1型骨折内固定物的选择更合理、钢板与骨折端外形的匹配更服贴、螺钉置入位置更可靠,提升了骨折内固定的生物力学性能.
목적 탐토술전수자화설계시부가이제고성인고골원단C1형골절강판내고정적효과.방법 취10대좌、우동원적성인고골습성표본,제작고골원단C1형골절모형,행CT소묘병장수거도입Mimics 14.0연강.우측위실험조(10구):진행골절삼유모형중건、삼유편집、허의내고정물치입급측량등술전수자화설계,이설계삼수지도실제내고정조작.좌측위대조조(10구):안상규골절수술원칙직접행내고정물치입.평개지표:①허의화실제내고정치입상사도평분(만분위10분),②실험조화대조조내고정후적우렬정도(골절복위만의도、강판도선적합이성、강판적복첩정도급라정치입위치),③생물역학압축실험,④내고정조작시간.결과 실험조허의화실제내고정적상사도평분평균위9.7분.실험조적골절복위만의도、강판도선적합이성、강판적복첩정도、라정치입위치、최대재하급단렬재하균우우대조조,차이유통계학의의(P＜0.05).실험조내고정조작시간[(32.5±3.2)min]단우대조조[(39.1±2.3)min],단총수술시간(술전설계시간+내고정조작시간)[(81.9±10.0)min]장우대조조[(39.1±2.3)min],차이균유통계학의의(P＜0.05).결론 술전수자화설계가사성인고골원단C1형골절내고정물적선택경합리、강판여골절단외형적필배경복첩、라정치입위치경가고,제승료골절내고정적생물역학성능.
Objective To evaluate the effectiveness of preoperative computer-assisted planning for plate fixation of adult C 1-type fracture of distal femur.Methods Ten pairs of cadaveric specimen of adult femur were used to create models of Cl-type fracture of distal femur.All models were subjected to spiral three-dimensional (3D) CT scan.The CT images were stored in DICOM format and transferred to a personal computer running MIMICS 14.0 software.In the experimental group (all 10 right sides),3D images reconstruction,3D editing,virtual plate and screws introduction,and measurement on virtual implants were performed to carry out a preoperative digital planning.The actual operations were then conducted strictly according to the parameters from virtual preoperative planning.In the control group (all 10 left sides),the fracture fixation was performed according to orthopaedic conventions.The evaluation system included:① similarity between virtual and actual implant fixation (10 points for perfection),② assessment of internal fixation quality in both groups (40 points for perfection),③ biomechanical compression test,and ④ time for internal fixation in both groups.Results The average score of the similarity between virtual and actual implant fixation was 9.7 points.The experimental group significantly surpassed the control group in fracture reduction,plate choice,implant fitness,screw insertion,maximum load and breaking load (P ＜ 0.05).The experimental group consumed significantly less time for internal fixation than the control group (32.5 ± 3.2 min versus 39.1 ± 2.3 min),but used significantly more time for the whole procedure (preoperative planning plus internal fixation) (81.9 ± 10.0 minversus 39.1 ± 2.3 min) (P ＜0.05).Conclusion Since computer-assisted digital preoperative planning can lead to more appropriate choice of implant,better fitness between plate and bone outline,and more accurate insertion of screws,it enhances the biomechanical performance of internal fixation.