3D模拟置钉方案在Sanders Ⅱ ～ Ⅳ型跟骨关节内骨折中的应用效果

目的分析3D模拟置钉方案在Sanders Ⅱ ～ Ⅳ型跟骨关节内骨折中的应用效果。方法选取2018年3月至2020年2月泸州市人民医院收治的106例Sanders Ⅱ ～ Ⅳ型跟骨关节内骨折患者，分为对照组（n=53）和观察组（n=53），对照组术前根据常规X线、64排螺旋CT扫描资料行手术方案设计及手术操作，观察组在对照组基础上将CT扫描数据导入Mimics 18.0软件进行后处理，依据骨折情况行术前模拟复位，然后进行手术方案设计及手术操作。两组患者术后均随访6个月，比较两组手术相关指标、并发症发生率、手术前后跟骨Böhler角和Gissane角、术后足部功能。结果观察组手术时间、每钉置钉时间、每足置钉时间、住院时间及骨折愈合时间均少于对照组（P<0.05），平均置钉数多于对照组（P<0.05），置钉准确率高于对照组（P<0.05）。观察组术后并发症发生率与对照组比较差异不显著（P>0.05）。术后6个月，两组跟骨Böhler角和Gissane角均增大（P<0.05），且观察组跟骨Böhler角和Gissane角均大于对照组（P<0.05）。术后6个月，两组美国矫形足踝协会（AOFAS）评分、Maryland评分均升高（P<0.05），且观察组AOFAS评分、Maryland评分均高于对照组（P<0.05）。结论 3D模拟置钉方案在Sanders Ⅱ～Ⅳ型跟骨关节内骨折中具有较佳应用效果，可以提升置钉质量，促进术后足部功能恢复。

英文摘要:

Objective To analyze the application effects of 3D simulated pedicle screw placement on Sanders type Ⅱ-Ⅳ intra-articular calcaneal fractures. Methods A total of 106 patients with Sanders type Ⅱ-Ⅳ intra-articular calcaneal fractures admitted to Luzhou People' s Hospital from March 2018 to February 2020 in were selected and divided into the control group(n=53)and the observation group (n=53). The control group performed surgical plan design and surgical procedures according to the conventional X-ray and 64-slice spiral CT scan data, and on the basis of the control group, the observation group imported the CT scan data into Mimics18.0 software for post-processing, and performed preoperative simulated reduction based on the fracture situation, and then proceeded to the surgical plan design and surgical procedure. Both groups of patients were followed up for 6 months after surgery. The surgery-related indicators, incidence rates of complications, calcaneal Böhler angle and Gissane angle before and after surgery and postoperative foot function were compared between the two groups. Results The surgical time, placement time per pedicle screw, pedicle screw placement time per foot, hospital stay and fracture healing time in the observation group were shorter than those in the control group (P<0.05), and the average number of pedicle screw placement was more than that in the control group (P<0.05), and the accuracy rate of pedicle screw placement was higher than that in the control group (P<0.05). The incidence rates of postoperative complications in the observation group were not significantly different from those in the control group (P>0.05). At 6 months after surgery, the calcaneal Böhler angle and Gissane angle of the two groups were increased (P<0.05), and the calcaneal Böhler angle and Gissane angle of the observation group were larger than those of the control group (P<0.05). At 6 months after surgery, the American Orthopaedic Foot and Ankle Society (AOFAS) score and Maryland score were increased in the two groups (P<0.05), and the AOFAS score and Maryland score in the observation group were higher than those in the control group (P<0.05). Conclusion 3D simulated pedicle screw placement has better application effects om Sanders type Ⅱ-Ⅳ intra-articular calcaneal fractures, and it can improve the quality of pedicle screw placement and promote postoperative foot function recovery.

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