Dye Nicholas B, Vagts Christen, Manson Theodore T, O'Toole Robert V
R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.
R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.
Injury. 2015 Feb;46(2):299-307. doi: 10.1016/j.injury.2014.08.005. Epub 2014 Aug 11.
No simple clinical technique with which to measure the volume of bone gaps in the treatment of open fractures or nonunions of the tibia is currently available. It is difficult to compare the three-dimensional magnitude of bone defects in research studies on bone grafting without such a tool, and clinicians have no way of determining the magnitude of defects in clinical practice. The purposes of this study were to develop and to validate a technique with which to accurately measure bone gap volumes of the tibial shaft by using only simple measurements on already available clinical radiographs and a simple equation. We hypothesized that a technique could be developed using anteroposterior- and lateral-view radiographs of the tibia to accurately determine the volume of a tibial shaft fracture.
We created standardized fracture gap models using 45 synthetic tibiae cut in different locations and orientations, rendering 135 gaps. We developed and validated a hydrostatic suspension technique to determine the volume of each bone, which underwent anteroposterior- and lateral-view radiography after each cut. Radiographic measurements were used to calculate defect volumes based on a simple equation. Predicted volumes were compared with measured volumes.
The triangular prism equation matched well with the actual volumes. Linear regression analysis showed a slope of 0.92 and R(2) of 0.97.
The equation provides a simple technique with which to calculate three-dimensional gap volumes based on standard radiographs. The simplicity of the equation and availability of standard radiographs make this a practical research and perhaps clinical tool that might be useful in quantifying volumes of the tibial shaft defect.
目前尚无简单的临床技术可用于测量胫骨开放性骨折或骨不连治疗中骨缺损的体积。在骨移植的研究中，若没有这样一种工具，就难以比较骨缺损的三维大小，并且临床医生在临床实践中也无法确定缺损的大小。本研究的目的是开发并验证一种技术，该技术仅通过对现有的临床X线片进行简单测量并运用一个简单方程，就能准确测量胫骨干的骨缺损体积。我们假设可以利用胫骨的前后位和侧位X线片开发一种技术，以准确确定胫骨干骨折的体积。
我们使用45根在不同位置和方向切割的合成胫骨创建了标准化的骨折间隙模型，得到135个间隙。我们开发并验证了一种静水悬浮技术来确定每根骨的体积，每切割一次后对其进行前后位和侧位X线摄影。基于一个简单方程，利用X线片测量值来计算缺损体积。将预测体积与测量体积进行比较。
三棱柱方程与实际体积匹配良好。线性回归分析显示斜率为0.92，R²为0.97。
该方程提供了一种基于标准X线片计算三维间隙体积的简单技术。该方程的简单性以及标准X线片的可得性使其成为一种实用的研究工具，或许在临床中也有用，可能有助于量化胫骨干缺损的体积。
