虚拟现实辅助小切口锁骨骨折内固定术

[目的]介绍虚拟现实辅助小切口治疗锁骨骨折的技术方法与初步临床效果。[方法]2016年7月~2019年9月在本院对35例锁骨骨折采用虚拟现实辅助小切口内固定治疗。术前行锁骨薄层CT扫描,数据导入到Mimics17.0软件中后,建立三维虚拟现实模型,对骨折进行复位,并对解剖型锁钉接骨板预选和预折弯,测量螺钉的直径和长度。术中于锁骨上两端分别做2 cm的切口,使用剥离器建立皮下通道后,插入预选的已塑形接骨板,分别在预置钉孔进行钻孔,拧入预选规格的螺钉。[结果]35例患者均顺利完成手术,无血管、神经损伤,手术操作时间(35.93±11.11)min,术中出血量(38.52±9.38)ml、透视次数(5.32±1.71)次,住院时间(6.79±0.61)d。仅1例患者切口浅表感染,经换药后愈合。随访6个月以上,随时间推移,患者疼痛逐渐减轻,患者肩部功能不断改善,末次随访时Neer评分为(94.58±2.18)分。[结论]虚拟现实辅助小切口治疗锁骨骨折患者,提升手术的精准性,减少医源性损伤。

Virtual reality assisted internal fixation through small incisions for clavicular fracture

[Objective]To introduce the technique and primary clinical outcomes of virtual reality assisted internal fixation through small incisions for clavicular fractures.[Methods]From July 2016 to September 2019,35 patients underwent virtual reality assisted internal fixation through same incisions for clavicular fractures.After thin slice CT scan conducted,the data were treated by Mimics software to create the 3-dimensional models of virtual reality.Subsequently,fracture reduction,accurate selection of a plate and screws,pre-bending of the plate and mimic operation were performed based on the virtual reality models before operation.During surgical operation,two small incisions 2 cm in length were made on surface of both ends of the clavicle,and a subcutaneous tunnel passed the two incisions was created by dissection.The plate and screws that selected and pre-bended according the perioperative 3-dimensional models of virtual reality were inserted into the subcutaneous tunnel to fit on the upper surface of the clavicle,and fixed following proper closed fracture reduction verified by fluoroscopy.[Results]All the 35 patients had operation performed smoothly without iatrogenic neurovascular injuries in anyone,whereas with operation of(35.93±11.11)min,intraoperative blood loss of(38.52±9.38)ml,X-ray exposure of(5.32±1.71)times and hospital stay of(6.79±0.61)days.Only 1 patient got superficial incision infection,which healed by dressing changes.As time went in follow up period lasted for more than 6 months,the patients were of pain relief and functional improvement with Neer score of(94.58±2.18)at the latest follow up.[Conclusion]This virtual reality assisted internal fixation through small incisions has benefits of improving surgical accuracy and reducing risk of iatrogenic injuries for treatment of clavicular fractures.