我们机构开发了第一个针对患者的生物力学模型,用于计划髋臼骨折的手术复位,并进行了回顾性验证。以前没有研究表明它在还原质量方面的有效性,手术时间和术中出血。因此,我们进行了一项病例对照研究,旨在:1)评估患者特异性生物力学模拟器术前模拟对手术时间和术中出血的影响;2)评估患者特异性生物力学模拟器术前模拟对复位质量的影响。
本病例对照研究包括在2019年1月至2019年6月期间通过生物力学模拟计划进行手术的所有患者。根据年龄和骨折类型,每个患者与我们数据库(2015-2018)中的2名对照进行匹配。术前高分辨率扫描仪提取DICOM数据,通过半自动分割建立骨折三维模型。建立了生物力学模型,以虚拟模拟手术复位的不同阶段。然后根据模拟数据进行手术。手术时间,失血,记录放射学结果和术中并发症,分析和比较。
包括30名患者,在模拟组中10个,在对照组中20个。两组在年龄方面具有可比性,从事故到手术的时间,骨折类型和手术入路。模拟组的平均手术时间显着减少:113min±33(60-180)与196min±32(60-260)(p=0.01)。模拟组的平均失血量显著减少:505mL±189(100-750)对745mL±130(200-850)(p<0.01)。然而,根据Matta的标准,放射学结果没有发现显著差异,尽管模拟组9例患者(90%)与对照组12例患者(60%)的解剖结构减少(p=0.26).对照组记录术后神经系统并发症(大腿外侧皮神经感觉障碍)。
这项研究证实了基于患者特异性生物力学模拟的髋臼创伤手术术前计划的有希望的结果,以及其在常规临床实践中的可行性。通过更好地了解断裂及其行为,减少术中出血和手术持续时间。
III;病例对照研究。
The first patient-specific biomechanical model for planning the surgical reduction of acetabular fractures was developed in our institution and validated retrospectively. There are no prior studies showing its effectiveness in terms of reduction quality, operative duration and intraoperative bleeding. Therefore, we performed a
case control study aiming to: 1) evaluate the effect of preoperative simulation by patient-specific biomechanical simulator on the operating time and intraoperative bleeding; 2) evaluate the effect of preoperative simulation by patient-specific biomechanical simulator on the quality of reduction.
All patients operated on between January 2019 and June 2019 after planning by biomechanical simulation were included in this
case-control study. Each patient included was matched to 2 controls from our database (2015-2018) according to age and fracture-type. DICOM data were extracted from the preoperative high-resolution scanners to build a three-dimensional model of the fracture by semi-automatic
segmentation. A biomechanical model was built to virtually simulate the different stages of surgical reduction. Surgery was then performed according to simulation data. Surgical duration, blood loss, radiological findings and intraoperative complications were recorded, analysed and compared.
Thirty patients were included, 10 in the simulation group and 20 in the control group. The two groups were comparable in terms of age, time from accident to surgery, fracture-type and surgical approach. The mean operative time was significantly reduced in the simulation group: 113min±33 (60-180) versus 196min±32 (60-260) (p=0.01). Mean blood loss was significantly reduced in the simulation group: 505mL±189 (100-750) versus 745mL±130 (200-850) (p<0.01). However, no significant difference was found in the radiological results according to Matta\'s criteria, although an anatomical reduction was obtained for 9 patients in the simulation group (90%) versus 12 patients in the control group (60%) (p=0.26). A postoperative neurological complication was recorded in the control group (sensory deficit of the lateral cutaneous nerve of thigh).
This study confirms the promising results of preoperative planning in acetabular trauma surgery based on patient-specific biomechanical simulation as well as its feasibility in routine clinical practice. By providing a better understanding of the fracture and its behavior, a reduction in intraoperative bleeding and in operative duration is achieved.
III;
case-control study.