留成胜 谢伟 李旱雨 吴向科 冯继华 兰云芬 聂俊 黎高明

[摘要] 目的 探讨数字化技术辅助手术和傳统切开复位内固定治疗复杂胫骨平台骨折的临床疗效。 方法 选取2015年12月至2020年3月期间我院收治复杂胫骨平台骨折患者88例，随机分为数字化组和传统组，每组各44例。术前均行CT扫描，数字化组将CT扫描数据导入Mimics软件进行三维重建，通过模型制定精准手术规划后行手术，传统组根据X线和CT影像学资料制定手术方案行手术。比较两组手术时间、术中出血量、术中透视次数和时间、住院时间、骨折愈合时间、完全负重时间、后倾及内翻角度等。末次随访采用膝关节Rasmussen评分和美国特种外科医院膝关节评分（HSS）对膝关节功能进行评价比较。 结果 数字化组手术时间、术中出血量、术中透视次数和时间、住院时间、骨折愈合时间、完全负重时间、后倾角度、内翻角度较传统组有明显优势，差异均有统计学意义（P<0.05）。数字化组HSS和Rasmessen评分优良率均高于传统组;两组HSS评分比较，差异有统计学意义（P<0.05）;两组Rasmessen评分比较，差异无统计学意义（P>0.05）。 结论 数字化技术辅助手术在治疗复杂胫骨平台骨折中表现出手术创伤小、出血量少、手术时间短、射线暴露少、复位精确性高及功能恢复快等优点。

[关键词] 数字化技术;胫骨平台;骨折;三维重建

[中图分类号] R683.1          [文献标识码] B          [文章编号] 1673-9701（2021）35-0085-06

Clinical effect of digital technology assisted treatment in complex tibial plateau fracture

LIU Chengsheng   XIE Wei   LI Hanyu   WU Xiangke   FENG Jihua   LAN Yunfen   NIE Jun   LI Gaoming

Department of Orthopaedics，Quzhou Hospital of Traditional Chinese Medicine in Zhejiang Province，Quzhou 324002，China

[Abstract] Objective To explore the clinical effects between the digital technology assisted surgery and the traditional open reduction and internal fixation in the treatment of complex tibial plateau fractures （TPF）. Methods A total of 88 cases of complex TPF were treated in our hospital from December 2015 to March 2020， were randomly divided into the digital group and the traditional group， each group has 44 cases. CT scanning was performed before operation. In the digital group， CT scanning data were input into Mimics software for three-dimensional reconstruction. The operation was performed after making accurate operation plans through the model. As for the traditional group， the operation plan was made according to X-ray and CT imaging data. The operation time，intraoperative hemorrhage volume， the intraoperative frequency and time of fluoroscopy， hospitalization time， fracture healing time，time to full weight bearing， backward inclination and varus angle were compared between the two groups. At the last follow-up，the knee joint function was evaluated and compared with the Rasmussen score of the knee joint and hospital for special surgery knee score （HSS）. Results Compared with the traditional group， the digital group had obvious advantages in terms of the operation time， the intraoperative hemorrhage volume， the intraoperative frequency and time of fluoroscopy， the hospitalization time，the fracture healing time，time to full weight bearing，backward inclination angle and varus angle，with statistically significant differences（P<0.05）.The excellent rates of HSS and Rasmessen scale were both higher in the digital group than those in the traditional group.There was significant difference in HSS score between the two groups while no significant difference was found in Rasmessen score between the two groups（P>0.05）. Conclusion The digital technology assisted surgery has the advantages of less trauma， less bleeding， short operation time， less radiation exposure， high reduction accuracy and quick functional recovery in the treatment of complex TPF.

[Key words] Digital technology; Tibial plateau; Fracture; Three-dimensional reconstruction

脛骨平台骨折为关节内骨折，占膝关节周围骨折的26.1%，近年来发病率呈逐年增加趋势[1]。高能损伤导致复杂胫骨平台骨折，关节面损伤严重，干骺端粉碎移位，常合并周围软组织损伤[2]。……