| Objective: By comparing the angle difference and insertion point deviation between the preoperative preset position and the actual postoperative placement position of percutaneous screw internal fixation for carpal navicular fractures under the guidance of 3D customized guiding templates,the causes of the error were analyzed.Follow up the recovery of wrist function of patients after surgery,explore the design improvement scheme of personalized 3D customized guiding templates,and optimize the surgical method.Methods: From January 2020 to December 2022,17 patients with carpal scaphoid fractures hospitalized in the Department of Hand and Foot Surgery,Affiliated Hospital of Jining Medical University,Shandong Province were selected to obtain informed consent from the patients,improve preoperative examination,and design a 3D customized guiding templates to assist percutaneous screw internal fixation for surgery.All the operations were performed by the same surgeon.After the operation,the wrist joint CT was reviewed and the data were exported for analysis.First,import.Dicom format data into Mimics software to perform 3D reconstruction of the scaphoid bone,reestablish an independent coordinate system,and perform a three-dimensional spatial comparison with the preoperative preset screw positions to compare their differences in angle on the X,Y,and Z coordinate axes for statistical analysis.Second,data in.Dicom format were imported into 3-Matic software to compare the differences in screw position,angle,and insertion point between preoperative and postoperative reconstruction of the scaphoid bone,and statistical analysis was performed.Analyze the cause of the deviation based on the results of the two angle deviations.Through the follow-up of the recovery of wrist joint motion(flexion,extension,rotation,ulnar deviation,radial deviation)in patients after surgery,the clinical practical effect of 3D customized guiding templates design was evaluated,and further improvement ideas were proposed for the guide plate design.Results: Postoperative CT scanning with 3D customized guiding templates assisted percutaneous screw insertion for patients with scaphoid fracture reconstructed the screw position and reset the three-dimensional spatial coordinate axis angle to be(X: 91.39 ± 8.35,Y: 90.23 ± 8.86,Z:10.51 ± 5.88)°.The preoperative design screw position and reset threedimensional spatial coordinate axis angle to be(X: 92.42 ± 7.16,Y: 93.60± 7.32,Z: 10.55 ± 6.56)°had no statistical significance(P > 0.05)There was no statistically significant difference in screw position after surgery.In the same coordinate system of the carpal scaphoid bone after surgery,the difference between the preoperative and postoperative screw positions was(12.59 ± 4.38)°,and the spacing between the insertion points was(3.65 ± 2.24)mm.The average follow-up period was 8 months(5 to 27months),including the average time.Compared with the healthy side,the wrist joint activity of the affected side recovered well,and there was no statistically significant difference between the flexion,back extension,radial deviation,ulnar deviation and the healthy side(P > 0.05).Conclusion: In the treatment of carpal scaphoid fracture with percutaneous internal fixation assisted by 3D customized guiding templates,there was no statistically significant difference between the screw placement position and the optimal preoperative position.However,there is still a certain difference between preoperative and postoperative coordinate axis angles,which may be related to factors such as stress and deformation of the scaphoid bone,displacement of the fracture end,and soft tissue swelling.In terms of guide plate design,screw trajectory design planning after reduction and reconstruction of the scaphoid bone may further improve the effect of screw placement.The design of this study provides a new idea for effective evaluation of screw insertion effects. |
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