He Yuanming, Liu Yang, Yin Bo, Wang Dong, Wang Hanzhou, Yao Peifeng, Zhou Junlin
Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
Front Surg. 2022 Feb 22;9:803541. doi: 10.3389/fsurg.2022.803541. eCollection 2022.
Distal femoral fractures are increasing with an aging population. The computer-assisted preoperative planning has great potential, but there are no preoperative plans to determine appropriate fixation methods for distal femoral fractures on an individual basis. The aims of this study are: (1) to describe the technique of finite element analysis combined with computer-assisted preoperative planning to determine a fixation method for distal femoral fractures and (2) to evaluate the intra-operative realization of this technology and the clinical outcomes based on it for distal femoral fractures.
Between January 2017 and January 2020, 31 patients with distal femoral fractures treated by open reduction and internal fixation were included and randomly divided into two groups based on preoperative planning methods: conventional group ( = 15) and computer-assisted group ( = 16). Firstly, how to determine the most appropriate plate and screw length and placement in the preoperative planning of distal femoral fractures was described. The time taken for preoperative planning for different fracture types in the computer-assisted group was then analyzed. Finally, intraoperative and postoperative parameters were compared between the conventional and computer-assisted groups, assessing operative time, intraoperative blood loss, number of intraoperative fluoroscopies, days of hospital stay, Visual Analog Scale for Pain Score (VAS), and Knee Society Score (KSS).
Mean total planning time for 33-A, 33-B, and 33-C fractures in computer-assisted group were 194.8 ± 6.49, 163.71 ± 9.22, and 237 ± 5.33 min, respectively. Compared with the conventional group, the patients in the computer-assisted group had less blood loss, fewer fluoroscopic images, and shorter operation time ( < 0.05). However, there was no significant difference in the hospitalization days, KSS score and VAS score between the two groups ( > 0.05).
The results of this study show that finite element combined with computer-assisted preoperative planning can effectively help surgeons to make accurate and clinically relevant preoperative planning for distal femoral fractures, especially in the selection of appropriate plate length and screw positioning.
随着人口老龄化，股骨远端骨折的发生率在增加。计算机辅助术前规划具有很大潜力，但目前尚无针对股骨远端骨折个体化确定合适固定方法的术前规划。本研究的目的是：（1）描述有限元分析结合计算机辅助术前规划以确定股骨远端骨折固定方法的技术；（2）评估该技术在股骨远端骨折手术中的实现情况及基于此的临床疗效。
2017年1月至2020年1月，纳入31例行切开复位内固定治疗的股骨远端骨折患者，根据术前规划方法随机分为两组：传统组（n = 15）和计算机辅助组（n = 16）。首先，描述在股骨远端骨折术前规划中如何确定最合适的钢板和螺钉长度及置入位置。然后分析计算机辅助组不同骨折类型术前规划所需时间。最后，比较传统组和计算机辅助组的术中及术后参数，评估手术时间、术中出血量、术中透视次数、住院天数、视觉模拟疼痛评分（VAS）和膝关节协会评分（KSS）。
计算机辅助组33 - A、33 - B和33 - C型骨折的平均总规划时间分别为194.8 ± 6.49、163.71 ± 9.22和237 ± 5.33分钟。与传统组相比，计算机辅助组患者出血量更少、透视图像更少、手术时间更短（P < 0.05）。然而，两组间住院天数、KSS评分和VAS评分差异无统计学意义（P > 0.05）。
本研究结果表明，有限元结合计算机辅助术前规划可有效帮助外科医生对股骨远端骨折进行准确且与临床相关的术前规划，尤其是在合适钢板长度的选择和螺钉定位方面。
