计算机辅助虚拟术前计划治疗皮隆骨折:回顾性倾向评分匹配队列研究。

IF 4.4 1区 医学 Q1 ORTHOPEDICS
Xiaoyang Jia, Kun Zhang, Minfei Qiang, Gengxin Jia, Tianhao Shi, Qinghui Han, Ying Wu, Yanxi Chen
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引用次数: 0

摘要

背景:术前计划是任何骨折手术治疗的关键。不幸的是,常规的规划方法并没有取得令人满意的结果。因此,本研究的目的是评估计算机辅助术前计划是否可以改善手术治疗的枕部骨折的预后。方法:2010年1月至2019年12月,611名东亚患者(≥18岁)被确诊为皮隆骨折。在排除107例患者后,最终队列包括504例患者:294例接受常规计划,210例接受计算机辅助术前计划。主要结局指标为12个月时的Olerud-Molander踝关节评分(OMAS)。次要结局是下肢功能、疼痛、生活质量、骨折复位质量以及与软组织和骨愈合相关的并发症。20个基线特征的倾向评分匹配产生204对患者。结果:整个队列504例患者中位年龄41岁(四分位数间距37 ~ 46岁),男性375例(74.4%)。配对后(408例;每个队列204例患者),接受计算机辅助术前计划的患者在12个月时的平均OMAS值(80.3点[95% CI, 79.5至81.1])优于使用常规计划方法的患者(73.2点[95% CI, 72.5至74.0];平均差值为-7.1点[95% CI, -8.2至-6.0];P < 0.001)。同样,计算机辅助计划组在下肢功能、疼痛、生活质量和复位质量方面观察到更好的结果。接受计算机辅助计划的患者软组织并发症发生率(9.3%[204例中19例])低于接受常规计划的患者(18.6%[204例中38例]);绝对比率差,-9.3% [95% CI, -16.1%至-2.6%];相对危险度为0.45 [95% CI, 0.25 ~ 0.81];P = 0.008),但在骨愈合并发症方面差异无统计学意义。结论:在头枕骨折患者中,与使用常规计划方法相比,使用计算机辅助术前计划可获得更好的功能和影像学结果,并降低软组织并发症的发生率。证据等级:诊断级III。有关证据水平的完整描述,请参见作者说明。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Computer-Assisted Virtual Preoperative Planning for the Treatment of Pilon Fractures: A Retrospective Propensity Score-Matched Cohort Study.

Background: Preoperative planning is critical for the operative management of any fracture. Unfortunately, conventional planning methods for pilon fractures have not yielded satisfactory results. Therefore, the purpose of this study was to evaluate whether the outcomes of surgically treated pilon fractures could be improved with computer-assisted preoperative planning.

Methods: Between January 2010 and December 2019, 611 East Asian patients (≥18 years old) with a pilon fracture were identified. After 107 patients were excluded, the final cohort comprised 504 patients: 294 received conventional planning and 210 received computer-assisted preoperative planning. The primary outcome measure was the Olerud-Molander Ankle Score (OMAS) at 12 months. The secondary outcomes were lower-limb function, pain, quality of life, quality of fracture reduction, and complications related to soft-tissue and bone healing. Propensity score matching for 20 baseline characteristics yielded 204 patient pairs.

Results: In the entire cohort of 504 patients, the median age was 41 years (interquartile range, 37 to 46 years) and 375 patients (74.4%) were male. After matching (408 patients; 204 patients in each cohort), patients who received computer-assisted preoperative planning had a better mean OMAS value at 12 months (80.3 points [95% CI, 79.5 to 81.1]) than patients for whom the conventional planning method was used (73.2 points [95% CI, 72.5 to 74.0]; mean difference, -7.1 points [95% CI, -8.2 to -6.0]; p < 0.001). Similarly, better outcomes were observed for lower-limb function, pain, quality of life, and reduction quality in the computer-assisted planning group. Patients who received computer-assisted planning had a lower rate of soft-tissue complications (9.3% [19 of 204 patients]) than patients who received conventional planning (18.6% [38 of 204 patients]; absolute rate difference, -9.3% [95% CI, -16.1% to -2.6%]; relative risk, 0.45 [95% CI, 0.25 to 0.81]; p = 0.008), but a significant difference was not found with respect to bone-healing complications.

Conclusions: In patients with a pilon fracture, the use of computer-assisted preoperative planning yielded better functional and radiographic outcomes and a lower rate of soft-tissue complications compared with the use of conventional planning methods.

Level of evidence: Diagnostic Level III . See Instructions for Authors for a complete description of levels of evidence.

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来源期刊
CiteScore
8.90
自引率
7.50%
发文量
660
审稿时长
1 months
期刊介绍: The Journal of Bone & Joint Surgery (JBJS) has been the most valued source of information for orthopaedic surgeons and researchers for over 125 years and is the gold standard in peer-reviewed scientific information in the field. A core journal and essential reading for general as well as specialist orthopaedic surgeons worldwide, The Journal publishes evidence-based research to enhance the quality of care for orthopaedic patients. Standards of excellence and high quality are maintained in everything we do, from the science of the content published to the customer service we provide. JBJS is an independent, non-profit journal.
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