文章摘要
夏胜利,娄玉健,王彬,吴佳俊,崔崟,王秀会.计算机辅助术前计划在跟骨骨折微创手术中的应用.骨科,2019,10(1):37-42
计算机辅助术前计划在跟骨骨折微创手术中的应用
Application of computer assisted pre-operative plan in minimally invasive surgery for the treatment of calcaneal fractures
投稿时间:2018-08-17  
DOI:10.3969/j.issn.1674-8573.2019.01.007
中文关键词: 计算机辅助设计  术前计划  跟骨骨折  骨折内固定术
英文关键词: Computer-aided design  Pre-operative plan  Calcaneal fractures  Fractures internal fixation
基金项目:上海市浦东新区卫计委科研资助项目(PW2014A-46);上海市浦东新区卫生局学科带头人培养计划资助项目(PWRD2011-07)
作者单位E-mail
夏胜利 上海市浦东新区周浦医院骨科上海 201318 victorxia@126.com 
娄玉健 上海市浦东新区周浦医院骨科上海 201318  
王彬 上海市浦东新区周浦医院骨科上海 201318  
吴佳俊 上海市浦东新区周浦医院骨科上海 201318  
崔崟 上海市浦东新区周浦医院骨科上海 201318  
王秀会 上海市浦东新区周浦医院骨科上海 201318  
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中文摘要:
      目的 探讨计算机辅助术前计划在跟骨关节内移位型骨折微创手术治疗中的应用价值。方法 回顾分析2013年2月至2015年12月期间,我院采用计算机辅助术前计划治疗的55例跟骨骨折病例的临床资料。所有病例均采用经跗骨窦切口入路复位及微型钢板内固定手术,记录术前手术设计及手术时间,评估术前骨折移位及术后骨折复位内固定情况,采用美国足踝外科医师协会(American Orthopaedic Foot and Ankle Society, AOFAS)踝与后足功能评分系统评价患侧足功能,采用疼痛视觉模拟量表(visual analogue scale, VAS)评估疼痛情况,收集并记录并发症发生情况。结果 55例病人均采用计算机辅助术前计划,平均术前计划时间为31 min,平均手术时间为86.7 min,术后影像学结果显示跟骨骨折复位及内固定满意,Böhlers角、Gissanes角及宽度得到充分矫正,后关节面平整度恢复;术后未发生手术切口切缘坏死、裂开或继发感染,无腓肠神经及腓骨长短肌腱损伤;所有病人获得平均21个月的随访,末次随访时AOFAS评分平均为88.7分,其中优30足(54.5%),良22足(40.0%),可3足(5.5%),优良率为94.5%,VAS评分平均为0.82分。结论 利用计算机对跟骨关节内移位型骨折进行术前手术设计,有利于术者术前明确骨折类型及完善手术方案,以指导跟骨骨折微创手术中的骨折复位及内固定物植入操作,从而获得良好的临床疗效。
英文摘要:
      Objective To explore the curative effect of computer assisted pre-operative plan in minimally invasive surgery for the treatment of intra-articular calcaneal fractures. Methods The clinical data of 55 patients with calcaneal fractures treated by computer assisted pre-operative plan in our hospital from February 2013 to December 2015 were retrospectively analyzed. All patients were treated by reduction through tarsal sinus incision and insertion of mini-plate internal fixation. The time of pre-operative design and operation was recorded. Pre-operative fracture displacement and post-operative reduction and internal fixation were evaluated. During the follow-up, the ankle and hind foot function was evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS), and the complications were collected and recorded. Results Fifty-five patients underwent computer assisted pre-operative plan. The average pre-operative plan time was 31 min and the average operation time was 86.7 min. Postoperative radiology showed satisfactory reduction and internal fixation of calcaneal fractures, Böhlers angle, Gissanes angle and width were fully corrected, and posterior articular surface flatness was restored. All surgical incisions got primary healing without wound complications including dehiscence, necrosis and infection, while the impairments of the fibularis tendons and the sural nerve were not found. All patients were followed up for an average of 21 months. At the last follow-up, the average AOFAS score was 88.7. Among them, 30 were excellent (54.5%), 22 were good (40.0%) and 3 were fair (5.5%). The excellent and good rate was 94.5%, and the average VAS score was 0.82. Conclusion Computer assisted pre-operative plan for displaced intra-articular calcaneal fractures can help surgeons identify type of the fractures and guide surgical technique for reduction and internal fixation with plates to obtain good clinical effects.
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