CAJ | 학술논문

目的：探讨三维重建技术在桡骨远端不稳定性骨折术前评估与规划中的应用价值。方法将行掌侧钢板内固定术的35例桡骨远端不稳定性骨折患者随机分为研究组（n=19）和对照组（n=16）。研究组将CT扫描图像数据导入MIMICS 13.0软件，重建骨折三维数字化模型，三维数据测量及模拟手术后再行手术治疗；对照组行常规手术治疗。评估并比较两组手术时间、术中出血量、术中X线暴露次数、住院时间、骨折愈合时间，术后6个月按照Gartland和Werley腕关节评分系统评定两组患者腕关节功能。结果研究组手术时间、术中出血量、术中X线暴露次数、住院时间均明显少于对照组，两组比较，差异有统计学意义（P＜0.05）。所有患者获得6～12个月随访（平均9个月），术后6个月研究组、对照组功能优良率和骨折愈合时间分别为18/19、15/16和（15.6±1.5）周、（16.9±1.8）周，两组比较，差异无统计学意义（P＞0.05）。两组术后均未见明显腕关节功能障碍，无感染或需再次手术调整内固定的病例。结论三维重建技术可清晰显示骨折部位的解剖结构，模拟手术过程，预制手术方案；基于三维重建技术的钢板内固定术具有手术时间短、术中出血量少、X线暴露次数少、住院时间短、功能恢复良好等特点，适用于桡骨远端不稳定性骨折。
목적：탐토삼유중건기술재뇨골원단불은정성골절술전평고여규화중적응용개치。방법장행장측강판내고정술적35례뇨골원단불은정성골절환자수궤분위연구조（n=19）화대조조（n=16）。연구조장CT소묘도상수거도입MIMICS 13.0연건，중건골절삼유수자화모형，삼유수거측량급모의수술후재행수술치료；대조조행상규수술치료。평고병비교량조수술시간、술중출혈량、술중X선폭로차수、주원시간、골절유합시간，술후6개월안조Gartland화Werley완관절평분계통평정량조환자완관절공능。결과연구조수술시간、술중출혈량、술중X선폭로차수、주원시간균명현소우대조조，량조비교，차이유통계학의의（P＜0.05）。소유환자획득6～12개월수방（평균9개월），술후6개월연구조、대조조공능우량솔화골절유합시간분별위18/19、15/16화（15.6±1.5）주、（16.9±1.8）주，량조비교，차이무통계학의의（P＞0.05）。량조술후균미견명현완관절공능장애，무감염혹수재차수술조정내고정적병례。결론삼유중건기술가청석현시골절부위적해부결구，모의수술과정，예제수술방안；기우삼유중건기술적강판내고정술구유수술시간단、술중출혈량소、X선폭로차수소、주원시간단、공능회복량호등특점，괄용우뇨골원단불은정성골절。
Objective To explore the application value of three-dimensional (3D) reconstruction in the treatment of unstable distal radius fracture. Methods Thirty-five patients with unstable distal radius fracture who performed plate internal fixation via a volar approach were randomly divided into observation group (n = 19) and control group (n = 16). Data of CT scanning in research group were imported into MIMICS 13.0 software, then 3D digital model of fracture were reconstructed, and the operation was performed after 3D parameters <br> measurement and simulation surgery; Patients in control group performed conventional surgery. Operative time, intraoperative estimate blood loss and X-ray exposure times, hospital stay, fracture healing time and wrist function 6 months after the operation (according to Gartland and Werley wrist scoring system) were evaluated and compared between two groups. Results The operative time, intraoperative estimate blood loss, X-ray exposure times and hospital stay in observation group were less than those in control group, the differences between two groups had statistical significance (P <0.05). All patients were followed up for 9 months (6-12 months). Six months after the operation, the excellent and good rate of wrist function, as well as frature healing time in observation group and control group was 18/19 and 15/16, (15.6 ± 1.5) weeks and (16.9 ± 1.8) weeks respectively, there were no statistical differences between two groups (P >0.05). No obvious wrist dysfunction were found, also, there were no infection or reoperation due to internal fixator complications in two groups. Conclusions With 3D reconstruction technique, anatomic structure of fracture site of distal radius can be displayed clearly, and the surgical procedure simulation and preoperative planning can be carried out. For unstable distal radius fracture, plate internal fixation based on 3D reconstruction is suitable due to its less operative time, intraoperative estimate blood loss, X-ray exposure times and hospital stay, as well as good function rehabilitation.