计算机辅助术前计划在跟骨骨折微创手术中的应用
|
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,B?hlers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。
Objective To explore the curative effect of computer assisted pre-operative plan inminimally invasive surgery for the treatment of intra-articular calcaneal fractures. Methods The clinical dataof 55 patients with calcaneal fractures treated by computer assisted pre-operative plan in our hospital fromFebruary 2013 to December 2015 were retrospectively analyzed. All patients were treated by reduction throughtarsal sinus incision and insertion of mini-plate internal fixation. The time of pre-operative design and operationwas recorded. Pre-operative fracture displacement and post-operative reduction and internal fixation wereevaluated. During the follow-up, the ankle and hind foot function was evaluated by the American OrthopaedicFoot and Ankle Society(AOFAS) and visual analogue scale(VAS), and the complications were collected andrecorded. 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 showedsatisfactory reduction and internal fixation of calcaneal fractures, B?hlers angle, Gissanes angle and width werefully corrected, and posterior articular surface flatness was restored. All surgical incisions got primary healingwithout wound complications including dehiscence, necrosis and infection, while the impairments of thefibularis 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 weregood(40.0%) and 3 were fair(5.5%). The excellent and good rate was 94.5%, and the average VAS score was0.82. Conclusion Computer assisted pre-operative plan for displaced intra-articular calcaneal fractures canhelp surgeons identify type of the fractures and guide surgical technique for reduction and internal fixation withplates to obtain good clinical effects.
Objective To explore the curative effect of computer assisted pre-operative plan inminimally invasive surgery for the treatment of intra-articular calcaneal fractures. Methods The clinical dataof 55 patients with calcaneal fractures treated by computer assisted pre-operative plan in our hospital fromFebruary 2013 to December 2015 were retrospectively analyzed. All patients were treated by reduction throughtarsal sinus incision and insertion of mini-plate internal fixation. The time of pre-operative design and operationwas recorded. Pre-operative fracture displacement and post-operative reduction and internal fixation wereevaluated. During the follow-up, the ankle and hind foot function was evaluated by the American OrthopaedicFoot and Ankle Society(AOFAS) and visual analogue scale(VAS), and the complications were collected andrecorded. 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 showedsatisfactory reduction and internal fixation of calcaneal fractures, B?hlers angle, Gissanes angle and width werefully corrected, and posterior articular surface flatness was restored. All surgical incisions got primary healingwithout wound complications including dehiscence, necrosis and infection, while the impairments of thefibularis 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 weregood(40.0%) and 3 were fair(5.5%). The excellent and good rate was 94.5%, and the average VAS score was0.82. Conclusion Computer assisted pre-operative plan for displaced intra-articular calcaneal fractures canhelp surgeons identify type of the fractures and guide surgical technique for reduction and internal fixation withplates to obtain good clinical effects.
引文
[1]Sharr PJ, Mangupli MM, Winson IG, et al. Current management options for displaced intra-articular calcaneal fractures:Non-opera-tive, ORIF, minimally invasive reduction and fixation or primaryORIF and subtalar arthrodesis. A contemporary review[J]. FootAnkle Surg, 2016, 22(1):1-8.
[2]Gotha HE, Zide JR. Current Controversies in Management of Calca-neus Fractures[J]. OrthopClin North Am, 2017, 48(1):91-103.
[3]Abdelazeem A, Khedr A, Abousayed M, et al. Management of dis-placed intra-articular calcaneal fractures using the limited open si-nus tarsi approach and fixation by screws only technique[J]. IntOrthop, 2014, 38(3):601-606.
[4]Smith WB. The Sinus Tarsi Approach for Calcaneal Fractures[J].Techniques in Foot and Ankle Surgery, 2013, 12(3):118-124
[5]Gomaa MA, Naggar AE, Anbar A. A modified minimally invasivetechnique for treatment of intra-articular fractures of the calcane-us. Mid-term results and review of the literature[J]. Eur Orthop-Traumatol, 2015, 6(4):305-313
[6]Kikuchi C, Charlton TP, Thordarson DB. Limited sinus tarsi ap-proach for intra-articular calcaneus fractures[J]. Foot Ankle Int,2013, 34(12):1689-1694
[7]Ko?odziejski P, Czarnocki?, Wojdasiewicz P, et al. Intraarticularfractures of calcaneus-current concepts of treatment[J]. Pol Or-thop Traumatol, 2014, 79:102-111.
[8]Eckardt H, Lind M. Effect of intraoperative three-dimensional im-aging during the reduction and fixation of displaced calcaneal frac-tures on articular congruence and implant fixation[J]. Foot AnkleInt, 2015, 36(7):764-773.
[9]Fadero PE, Shah M. Three dimensional(3D)modelling and surgi-cal planning in trauma and orthopaedics[J]. Surgeon, 2014, 12(6):328-333.
[10]Jiménez-Delgado JJ, Paulano-Godino F, PulidoRam-Ramírez R, etal. Computer assisted preoperative planning of bone fracture reduc-tion:simulation techniques and new trends[J]. Med Image Anal,2016, 30:30-45.
[11]Chen Y, Zhang K, Qiang M, et al. Computer-assisted preoperativeplanning for proximal humeral fractures by minimally invasiveplate osteosynthesis[J]. Chin Med J(Engl), 2014, 127(18):3278-3285.
[12]Bajammal S, Tornetta P 3rd, Sanders D, et al. Displaced intra-artic-ular calcaneal fractures[J]. J Orthop Trauma, 2005, 19(5):360-364.
[13]Veltman ES, Doornberg JN, Stufkens SA, et al. Long-term out-comes of 1,730 calcaneal fractures:systematic review of the litera-ture[J]. J Foot Ankle Surg, 2013, 52(4):486-490.
[14]Kline AJ, Anderson RB, Davis WH, et al. Minimally invasive tech-nique versus an extensile lateral approach for intra-articular calca-neal fractures[J]. Foot Ankle Int, 2013, 34(6):773-780.
[15]Holmes GB. Treatment of displaced calcaneal fractures using asmall sinus tarsi approach[J]. Tech Foot Ankle Surg, 2005, 4(1):35-41.
[16]Yeo JH, Cho HJ, Lee KB. Comparison of two surgical approachesfor displaced intra-articular calcaneal fractures:sinus tarsi versusextensile lateral approach[J]. BMC Musculoskelet Disord,2015,16:63.
[17]Femino JE, Vaseenon T, Levin DA, et al. Modification of the sinustarsi approach for open reduction and plate fixation of intra-articu-lar calcaneus fractures:the limits of proximal extension based up-on the vascular anatomy of the lateral calcaneal artery[J]. IowaOrthop J, 2010, 30:161-167.
[18]Stapleton JJ, Zgonis T. Surgical treatment of intra-articular calcane-al fractures[J]. ClinPodiatr Med Surg, 2014, 31(4):539-546.
[19]Epstein N, Chandran S, Chou L. Current concepts review:intra-articular fractures of the calcaneus[J]. Foot Ankle Int, 2012, 33(1):79-86.
[20]Takasaka M, Bittar CK, Mennucci FS, et al. Comparative study onthree surgical techniques for intra-articular calcaneal fractures:open reduction with internal fixation using a plate, external fixa-tion and minimally invasive surgery[J]. Rev Bras Ortop, 2016, 51(3):254-260.
[21]Pastides PS, Milnes L, Rosenfeld PF. Percutaneous arthroscopiccalcaneal osteosynthesis:a minimally invasive technique for dis-placed intra-articular calcaneal fractures[J]. J Foot Ankle Surg,2015, 54(5):798-804.
[22]Chung KJ, Hong DY, Kim YT, et al. Preshaping plates for minimal-ly invasive fixation of calcaneal fractures using a real-size 3D-printed model as a preoperative and intraoperative tool[J]. FootAnkle Int, 2014, 35(11):1231-1236.
[23]Sampath Kumar V, Marimuthu K, Subramani S, et al. Prospectiverandomized trial comparing open reduction and internal fixationwith minimally invasive reduction and percutaneous fixation inmanaging displaced intra-articular calcaneal fractures[J]. Int Or-thop, 2014, 38(12):2505-2512.
[24]Kwon JY, Zurakowski D, Ellington JK. Influence of contralateralradiographs on accuracy of anatomic reduction in surgically treat-ed calcaneus fractures[J]. Foot Ankle Int, 2015, 36(1):75-82.
[2]Gotha HE, Zide JR. Current Controversies in Management of Calca-neus Fractures[J]. OrthopClin North Am, 2017, 48(1):91-103.
[3]Abdelazeem A, Khedr A, Abousayed M, et al. Management of dis-placed intra-articular calcaneal fractures using the limited open si-nus tarsi approach and fixation by screws only technique[J]. IntOrthop, 2014, 38(3):601-606.
[4]Smith WB. The Sinus Tarsi Approach for Calcaneal Fractures[J].Techniques in Foot and Ankle Surgery, 2013, 12(3):118-124
[5]Gomaa MA, Naggar AE, Anbar A. A modified minimally invasivetechnique for treatment of intra-articular fractures of the calcane-us. Mid-term results and review of the literature[J]. Eur Orthop-Traumatol, 2015, 6(4):305-313
[6]Kikuchi C, Charlton TP, Thordarson DB. Limited sinus tarsi ap-proach for intra-articular calcaneus fractures[J]. Foot Ankle Int,2013, 34(12):1689-1694
[7]Ko?odziejski P, Czarnocki?, Wojdasiewicz P, et al. Intraarticularfractures of calcaneus-current concepts of treatment[J]. Pol Or-thop Traumatol, 2014, 79:102-111.
[8]Eckardt H, Lind M. Effect of intraoperative three-dimensional im-aging during the reduction and fixation of displaced calcaneal frac-tures on articular congruence and implant fixation[J]. Foot AnkleInt, 2015, 36(7):764-773.
[9]Fadero PE, Shah M. Three dimensional(3D)modelling and surgi-cal planning in trauma and orthopaedics[J]. Surgeon, 2014, 12(6):328-333.
[10]Jiménez-Delgado JJ, Paulano-Godino F, PulidoRam-Ramírez R, etal. Computer assisted preoperative planning of bone fracture reduc-tion:simulation techniques and new trends[J]. Med Image Anal,2016, 30:30-45.
[11]Chen Y, Zhang K, Qiang M, et al. Computer-assisted preoperativeplanning for proximal humeral fractures by minimally invasiveplate osteosynthesis[J]. Chin Med J(Engl), 2014, 127(18):3278-3285.
[12]Bajammal S, Tornetta P 3rd, Sanders D, et al. Displaced intra-artic-ular calcaneal fractures[J]. J Orthop Trauma, 2005, 19(5):360-364.
[13]Veltman ES, Doornberg JN, Stufkens SA, et al. Long-term out-comes of 1,730 calcaneal fractures:systematic review of the litera-ture[J]. J Foot Ankle Surg, 2013, 52(4):486-490.
[14]Kline AJ, Anderson RB, Davis WH, et al. Minimally invasive tech-nique versus an extensile lateral approach for intra-articular calca-neal fractures[J]. Foot Ankle Int, 2013, 34(6):773-780.
[15]Holmes GB. Treatment of displaced calcaneal fractures using asmall sinus tarsi approach[J]. Tech Foot Ankle Surg, 2005, 4(1):35-41.
[16]Yeo JH, Cho HJ, Lee KB. Comparison of two surgical approachesfor displaced intra-articular calcaneal fractures:sinus tarsi versusextensile lateral approach[J]. BMC Musculoskelet Disord,2015,16:63.
[17]Femino JE, Vaseenon T, Levin DA, et al. Modification of the sinustarsi approach for open reduction and plate fixation of intra-articu-lar calcaneus fractures:the limits of proximal extension based up-on the vascular anatomy of the lateral calcaneal artery[J]. IowaOrthop J, 2010, 30:161-167.
[18]Stapleton JJ, Zgonis T. Surgical treatment of intra-articular calcane-al fractures[J]. ClinPodiatr Med Surg, 2014, 31(4):539-546.
[19]Epstein N, Chandran S, Chou L. Current concepts review:intra-articular fractures of the calcaneus[J]. Foot Ankle Int, 2012, 33(1):79-86.
[20]Takasaka M, Bittar CK, Mennucci FS, et al. Comparative study onthree surgical techniques for intra-articular calcaneal fractures:open reduction with internal fixation using a plate, external fixa-tion and minimally invasive surgery[J]. Rev Bras Ortop, 2016, 51(3):254-260.
[21]Pastides PS, Milnes L, Rosenfeld PF. Percutaneous arthroscopiccalcaneal osteosynthesis:a minimally invasive technique for dis-placed intra-articular calcaneal fractures[J]. J Foot Ankle Surg,2015, 54(5):798-804.
[22]Chung KJ, Hong DY, Kim YT, et al. Preshaping plates for minimal-ly invasive fixation of calcaneal fractures using a real-size 3D-printed model as a preoperative and intraoperative tool[J]. FootAnkle Int, 2014, 35(11):1231-1236.
[23]Sampath Kumar V, Marimuthu K, Subramani S, et al. Prospectiverandomized trial comparing open reduction and internal fixationwith minimally invasive reduction and percutaneous fixation inmanaging displaced intra-articular calcaneal fractures[J]. Int Or-thop, 2014, 38(12):2505-2512.
[24]Kwon JY, Zurakowski D, Ellington JK. Influence of contralateralradiographs on accuracy of anatomic reduction in surgically treat-ed calcaneus fractures[J]. Foot Ankle Int, 2015, 36(1):75-82.