PDF(Pubmed)
Abstract：
As non-unions are still common, a predictive assessment of healing complications could enable immediate intervention before negative impacts for the patient occur. The aim of this pilot study was to predict consolidation with the help of a numerical simulation model. A total of 32 simulations of patients with closed diaphyseal femoral shaft fractures treated by intramedullary nailing (PFNA long, FRN, LFN, and DePuy Synthes) were performed by creating 3D volume models based on biplanar postoperative radiographs. An established fracture healing model, which describes the changes in tissue distribution at the fracture site, was used to predict the individual healing process based on the surgical treatment performed and full weight bearing. The assumed consolidation as well as the bridging dates were retrospectively correlated with the clinical and radiological healing processes. The simulation correctly predicted 23 uncomplicated healing fractures. Three patients showed healing potential according to the simulation, but clinically turned out to be non-unions. Four out of six non-unions were correctly detected as non-unions by the simulation, and two simulations were wrongfully diagnosed as non-unions. Further adjustments of the simulation algorithm for human fracture healing and a larger cohort are necessary. However, these first results show a promising approach towards an individualized prognosis of fracture healing based on biomechanical factors.
摘要：
由于非工会仍然很普遍，对治愈并发症的预测性评估可以在对患者产生负面影响之前立即进行干预.这项初步研究的目的是借助数值模拟模型预测固结。总共32例模拟了通过髓内钉治疗的闭合性骨干股骨干骨折患者（PFNA长，FRN,LFN,和DePuySynthes）通过基于双平面术后X光片创建3D体积模型来进行。建立骨折愈合模型,描述了骨折部位组织分布的变化，用于根据所进行的手术治疗和完全负重来预测个体愈合过程。假定的巩固和桥接日期与临床和放射学愈合过程回顾性相关。该模拟正确预测了23个不复杂的愈合骨折。根据模拟，三名患者显示出治愈潜力，但临床上证明是不结合。通过模拟，六个不结合中有四个被正确检测为不结合，两次模拟被错误诊断为不结合。需要进一步调整人体骨折愈合的模拟算法和更大的队列。然而,这些初步结果显示了基于生物力学因素的骨折愈合个体化预后的有希望的方法.
