Charilaou Johan, Dey Roopam, Burger Marilize, Sivarasu Sudesh, van Staden Ruan, Roche Stephen
Department of Surgery, Division of Orthopaedic Surgery, Groote Schuur Hospital, 7935 Cape Town, South Africa.
Department of Surgery, Division of Orthopaedic Surgery, Groote Schuur Hospital, 7935 Cape Town, South Africa - Department of Human Biology, Division of Biomedical Engineering, University of Cape Town, 7935 Cape Town, South Africa.
SICOT J. 2021;7:36. doi: 10.1051/sicotj/2021028. Epub 2021 May 20.
Surgical treatment of displaced acromial and scapula spine fractures may be challenging due to the bony anatomy and variable fracture patterns. This difficulty is accentuated by the limitations of the available scapular plates for fracture fixation. This study compares the quantitative fitting of anatomic scapular plates and clavicle plates, using three-dimensional (3D) printed fractured scapulae.
Fourteen scapulae with acromion and spine fractures were used for this study. Computerized tomographic (CT) scans of the fractured scapulae were obtained from the Philips picture archiving and communication system (PACS) database of patients admitted to a tertiary teaching hospital in Cape Town, South Africa between 2012 and 2016. The reconstructed scapulae were 3D printed and the anatomical acromion and clavicle plates were templated about the fracture regions. The fit assessment was performed by five observers who classified the plates as no-fit, intermediate fit, and anatomical fit according to the surgical guidelines.
The 6-hole anterior clavicle plate performed better than any of the scapular plates as they were able to fit 45.7% of the fractured acromion, including the spine. Among the pre-contoured anatomical scapula plates, both the short and the long acromion plates could fit only 27.3% of the fractured acromion. The intraclass correlation coefficient was 0.965 suggesting excellent consensus among the five observers.
Clavicle plates were found to be better suited to fit around a scapula fracture in its acromion and spine region.
由于肩胛骨的骨解剖结构和骨折模式多样，移位性肩峰和肩胛冈骨折的手术治疗可能具有挑战性。现有的用于骨折固定的肩胛骨钢板的局限性进一步加剧了这一困难。本研究使用三维（3D）打印的骨折肩胛骨，比较解剖型肩胛骨钢板和锁骨钢板的定量贴合情况。
本研究使用了14例伴有肩峰和肩胛冈骨折的肩胛骨。从南非开普敦一家三级教学医院2012年至2016年收治患者的飞利浦图像存档与通信系统（PACS）数据库中获取骨折肩胛骨的计算机断层扫描（CT）图像。将重建后的肩胛骨进行3D打印，并在骨折区域放置解剖型肩峰和锁骨钢板模板。由五名观察者根据手术指南将钢板分为不贴合、中度贴合和解剖学贴合三类进行贴合评估。
6孔前侧锁骨钢板的表现优于任何一种肩胛骨钢板，它能够贴合45.7%的包括肩胛冈在内的骨折肩峰。在预塑形的解剖型肩胛骨钢板中，短肩峰钢板和长肩峰钢板均只能贴合27.3%的骨折肩峰。组内相关系数为0.965，表明五名观察者之间具有高度一致性。
发现锁骨钢板更适合于围绕肩胛骨骨折的肩峰和肩胛冈区域进行贴合。
