Department of Medical Imaging, Ningbo No.6 Hospital, 315000 Ningbo, Zhejiang, China.
Department of Orthopedics, Ningbo No.6 Hospital, 315000 Ningbo, Zhejiang, China.
Ann Ital Chir. 2024;95(4):648-656. doi: 10.62713/aic.3382.
This study aimed to evaluate the hypothesis that the utilization of percutaneous screw guides enhances the precision of screw placement in the surgical fixation of talar fractures.
Computed tomography (CT) scans of ankle joints were obtained from 40 healthy adults and 10 cadaveric specimens between April 2019 and August 2020 at Ningbo No. 6 Hospital. The acquired CT data were imported into Materialise Interactive Medical Image Control System (MIMICS) software for processing. Three-dimensional (3D) digital models of the ankle joints were reconstructed, and relevant anatomical parameters were measured. A percutaneous screw guide (PSG) was designed and fabricated to facilitate accurate screw placement in the posterior talar process. Ten eligible cadaveric ankle joints were selected for further analysis and their 3D models were reconstructed using the MIMICS software. Screw trajectory parameters were then measured and analyzed based on these cadaveric models, forming the model group for comparative analyses. Ten cadaveric specimens were utilized in this study, equally divided into two groups: a guider group (n = 5) and a free-hand group (n = 5). In the guider group, talar posterior process screws were inserted using percutaneous screw guidance. In the free-hand group, screws were inserted into the talar posterior process without guidance. Post-operative CT scans were performed on all specimens. The following parameters were quantitatively compared between the two groups: screw trajectories, entry point distances in specimens with preselected screws, entry point distance trajectories in the 3D model, operation time, frequency of fluoroscopic imaging, and number of drilling attempts.
Following the generation of the 3D models from 10 cadavers, a virtual screw was digitally inserted into each model. In the model group, the preselected screw trajectory was oriented towards the medial aspect of the talar neck base, with a cephalad inclination angle (CIA) of 3.1° ± 1.5° in the transverse~plane and a medial diverge angle (MDA) of 12.0° ± 1.4° in the coronal plane. The CIA and MDA of the screw trajectory in the guider group were 2.1° ± 1.7° and 11.2° ± 1.6°, respectively, whereas the CIA and MDA in the free-hand group were 6.0° ± 2.2° and 18.8° ± 1.6°, respectively. Statistical analysis revealed significant differences in both CIA and MDA between the two groups (p < 0.05). Furthermore, the guider group yielded superior outcomes in terms of entry point distance, operation time, fluoroscopic exposure time, and number of drilling attempts compared to the free-hand group (p < 0.05).
Percutaneous screw guidance can improve the accuracy and safety of the posterior process of the talar screws, which can be feasible for percutaneous fixation. Further studies are required to confirm the efficacy and clinical outcomes of percutaneous screw guidance.
本研究旨在验证经皮螺钉导板的应用是否能提高跗骨骨折手术固定中螺钉置入的精确性。
2019 年 4 月至 2020 年 8 月，在宁波市第六医院，我们从 40 名健康成年人和 10 名尸体标本中获取踝关节的计算机断层扫描（CT）扫描。获得的 CT 数据被导入 Materialise Interactive Medical Image Control System（MIMICS）软件进行处理。重建踝关节的三维（3D）数字模型，并测量相关解剖参数。设计并制作经皮螺钉导板（PSG），以方便在距骨后突准确放置螺钉。选择 10 个符合条件的尸体踝关节进行进一步分析，使用 MIMICS 软件重建其 3D 模型。然后根据这些尸体模型测量和分析螺钉轨迹参数，形成模型组进行比较分析。本研究共使用了 10 个尸体标本，分为两组：导板组（n = 5）和徒手组（n = 5）。在导板组中，使用经皮螺钉导板插入距骨后突螺钉。在徒手组中，不使用导板将螺钉插入距骨后突。所有标本均在术后进行 CT 扫描。对两组之间的以下参数进行定量比较：螺钉轨迹、预选螺钉标本的进钉点距离、3D 模型中的进钉点轨迹、手术时间、透视成像频率和钻孔尝试次数。
在从 10 具尸体生成 3D 模型后，在每个模型中都数字化插入了虚拟螺钉。在模型组中，预选螺钉轨迹朝向距骨颈基底的内侧，在横断面上的头倾角度（CIA）为 3.1°±1.5°，在冠状面上的内侧发散角（MDA）为 12.0°±1.4°。导板组的螺钉轨迹 CIA 和 MDA 分别为 2.1°±1.7°和 11.2°±1.6°，而徒手组的 CIA 和 MDA 分别为 6.0°±2.2°和 18.8°±1.6°。两组间 CIA 和 MDA 均有统计学差异（p < 0.05）。此外，导板组在进钉点距离、手术时间、透视暴露时间和钻孔尝试次数方面的结果均优于徒手组（p < 0.05）。
经皮螺钉导板可提高距骨后突螺钉的准确性和安全性，可用于经皮固定。需要进一步的研究来证实经皮螺钉导板的疗效和临床效果。
