Application Of Computer Assisted Technique In The Staging Treatment Of Tibial Plateau Fractures

Objective: To investigate the clinical effect of early external fixation combined with delayed open reduction fixation for the treatment of complex tibial plateau fractures due to the high treatment difficulty and high complications of complex tibial plateau.The mixed reality technology was introduced into the bone visualization of the tibial plateau to verify the accuracy of its positioning.A series of computer assisted techniques were used in the open reduction and internal fixation to verify its feasibility.Methods: A retrospective analysis of 34 patients with complex tibial plateau fractures with dislocation was performed in two groups,with early calcaneus traction combined with delayed open reduction fixation and early external fixation combined with delayed open reduction fixation.The operation time,postoperative complications,bone healing time,knee mobility,starting weight bearing time,Rasmussen tibial plateau anatomical score,and HSS knee function score were compared between the two groups.The tibial plateau model fixed by the external fixation bracket was established,and the three-dimensional visualization of the tibial plateau was realized by the mixed reality technology based on the Hololens platform registered by the two-dimensional code.The virtual point was designed in three models,and the mixed reality environment was prepared according to the preoperative planning.Under the device positioning,the error between the two points was compared.A staging strategy was used to treat a complicated case of tibial plateau fracture.The virtual surgery planning and 3D printing-assisted surgical planning were performed during the waiting period.The three-dimensionalreconstruction of the tibial plateau was performed by the Hololos platform-based mixed reality technique.Visualize and guide the surgery to analyze postoperative outcomes.Results: A total of 34 patients were followed up for an average of 18.64 months.There were significant statistical differences between the two groups in the time of operation,postoperative complications and initial weight-bearing time.All of the external fixation group were superior to the calcaneus traction group.There was no statistically significant difference in the time of bone healing,joint mobility,Rasmussen tibial plateau anatomical score and HSS knee joint function.Through the sacral bone model experiment,the three-dimensional visualization of the tibial plateau was realized,and the real-time virtual and real image matching fusion could be realized by capturing the two-dimensional code information in real time.Comparing the position of the preoperative design virtual point with the actual postoperative position,the results showed that,and the average displacement difference was 1.54±0.26 mm of the three models with a total of 54 points.The average displacement difference of 18 points in each model of the 2nd,3rd,and 4th models was 1.59±0.29 mm,1.56±0.31 mm,and 1.48±0.17 mm,respectively.There was no statistically significant difference in the difference in displacement between the groups.A series of computer-assisted techniques were used to treat 1 case of complicated tibial plateau fractures without obvious early complications.The Rasmussen tibial plateau anatomy score was rated 16 points.The follow-up at 8months postoperatively showed that the patient was firmly fixed and no failure occurred.The HSS knee function score was 89 points,and the knee joint had no obvious internal valgus,and the flexion was up to 115°.Conclusion: The use of external fixation combined with delayed open reduction and internal fixation for complex tibial plateau fractures with dislocation is a feasibleand safe and effective treatment.The Hybrid Reality technology based on the Hololens platform enables intraoperative three-dimensional visualization of the tibial plateau and enables accurate positioning of the tibial plateau.Computer-assisted technology can improve the preoperative planning quality of stage II surgery,combined with intraoperative mixed reality technology to achieve fracture visualization,providing a new auxiliary technology for clinical treatment of this case.