Thomas Thaddeus P, Anderson Donald D, Willis Andrew R, Liu Pengcheng, Frank Matthew C, Marsh J Lawrence, Brown Thomas D
Department of Orthopaedics and Rehabilitation, The University of Iowa, Iowa City, USA.
Comput Methods Biomech Biomed Engin. 2011 Mar;14(3):263-70. doi: 10.1080/10255841003762042.
Reconstructing highly comminuted articular fractures poses a difficult surgical challenge, akin to solving a complicated three-dimensional (3D) puzzle. Preoperative planning using computed tomography (CT) is critically important, given the desirability of less invasive surgical approaches. The goal of this work is to advance 3D puzzle-solving methods towards use as a preoperative tool for reconstructing these complex fractures. A methodology for generating typical fragmentation/dispersal patterns was developed. Five identical replicas of human distal tibia anatomy were machined from blocks of high-density polyetherurethane foam (bone fragmentation surrogate), and were fractured using an instrumented drop tower. Pre- and post-fracture geometries were obtained using laser scans and CT. A semi-automatic virtual reconstruction computer program aligned fragment native (non-fracture) surfaces to a pre-fracture template. The tibiae were precisely reconstructed with alignment accuracies ranging from 0.03 to 0.4 mm. This novel technology has the potential to significantly enhance surgical techniques for reconstructing comminuted intra-articular fractures, as illustrated for a representative clinical case.
重建高度粉碎性关节骨折是一项艰巨的外科挑战，类似于解决一个复杂的三维（3D）拼图。鉴于希望采用侵入性较小的手术方法，使用计算机断层扫描（CT）进行术前规划至关重要。这项工作的目标是推进3D拼图解决方法，使其用作术前重建这些复杂骨折的工具。开发了一种生成典型破碎/分散模式的方法。从高密度聚醚聚氨酯泡沫块（骨破碎替代物）加工出五个相同的人类胫骨远端解剖结构复制品，并使用仪器化落塔使其骨折。使用激光扫描和CT获取骨折前后的几何形状。一个半自动虚拟重建计算机程序将碎片的原始（未骨折）表面与骨折前模板对齐。胫骨被精确重建，对齐精度范围为0.03至0.4毫米。如一个代表性临床病例所示，这项新技术有可能显著提高重建粉碎性关节内骨折的手术技术。
