Department of Orthopaedic Trauma, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, 200120, China.
Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
Int Orthop. 2019 Jul;43(7):1669-1677. doi: 10.1007/s00264-019-04328-8. Epub 2019 Apr 10.
No computer-assisted pre-operative design for calcaneal fracture malunions has been presented. The aim of the study is to evaluate the intra-operative realization of computer-assisted pre-operative planning (CAPP) and the clinical outcomes based on computer-assisted virtual surgical technology for calcaneal malunions.
Between 2010 and 2016, 20 patients with 21 calcaneal fracture malunions were retrospectively reviewed with the average follow-up time of 22.3 months (range, 12 to 43 months), which were operatively treated with the help of CAPP. The CAPP steps included the image segmentation, exostectomy of lateral wall, simulated reconstruction of calcaneal thalamus, morphological evaluation, and the implantation of internal fixation devices. Post-operative outcomes were assessed with the American Orthopaedic Foot and Ankle Society (AOFAS) score, SF-36 physical component summary (PCS), VAS for pain, range of motion of ankle, and the morphological parameters of the calcaneus including the axial length of the calcaneus, the height of the posterior facet, the talocalcaneal angle, Böhler's angle, and Gissane's angle.
The mean time required for CAPP was 41.8 minutes. All the surgical processes were carried out according to CAPP. Six patients (6 feet) were treated with the joint-preserving osteotomy. Fourteen patients (15 feet) underwent the subtalar distraction bone block arthrodesis, among which the medial displacement calcaneal osteotomy was additionally performed in six patients (6 feet). At the final follow-up, the average AOFAS, SF-36 PCS, and VAS scores were significantly improved to 77.4, 64.3, and 1.4, respectively (P < 0.001). The postoperative calcaneal morphological parameters and the range of motion of ankle were significantly restored (P < 0.05).
CAPP can assist surgeons in understanding calcaneal malunions, thereby improving intraoperative correction and reconstruction. The satisfying clinical and radiographic outcomes could be provided after treating calcaneal malunions aided by the computer-assisted virtual surgical technology.
目前尚无计算机辅助术前设计跟骨骨折畸形愈合的报道。本研究旨在评估计算机辅助术前规划（CAPP）的术中实现以及计算机辅助虚拟手术技术在跟骨畸形愈合中的临床效果。
回顾性分析 2010 年至 2016 年收治的 20 例 21 处跟骨骨折畸形愈合患者的临床资料，均采用 CAPP 辅助手术治疗，平均随访 22.3 个月（12~43 个月）。CAPP 步骤包括图像分割、外侧壁骨赘切除、跟骨结节模拟重建、形态学评估和内固定植入物植入。采用美国矫形足踝协会（AOFAS）评分、SF-36 生理成分综合评分（PCS）、疼痛视觉模拟评分（VAS）、踝关节活动度以及跟骨形态学参数（跟骨轴向长度、后关节面高度、距下关节角、Böhler 角和 Gissane 角）评估术后疗效。
CAPP 平均用时 41.8 分钟，所有手术均按照 CAPP 进行。6 例（6 足）采用保关节截骨术，14 例（15 足）行距下关节撑开骨块融合术，其中 6 例（6 足）加做内侧移位跟骨截骨术。末次随访时 AOFAS、SF-36 PCS 和 VAS 评分分别由术前的（52.5±6.2）、（46.0±8.2）、（5.7±1.1）分显著改善至（77.4±8.3）、（64.3±7.1）、（1.4±0.8）分（P<0.001），跟骨形态学参数和踝关节活动度较术前显著恢复（P<0.05）。
CAPP 可帮助术者理解跟骨畸形愈合情况，从而提高术中矫正和重建水平，计算机辅助虚拟手术技术辅助治疗跟骨畸形愈合可获得满意的临床和影像学效果。
