Application Of Three-Dimensional Imaging Technology In Diagnosis,treatment And Prognosis Of Distal Radius Fracture

Distal radius fracture is one of the most common fractures in adults,with an incidence of about 17% of all fractures.Overall,the lifetime risk of distal radius fractures is about 15% in women and about 2% in men.Such fractures often occur when the back of the palm extends to 40 °-90 ° when falling.The fracture is usually 1.5cm-2.5cm proximal to the edge of wrist joint.About 50%-55% of patients with distal radius fractures are accompanied by ulnar styloid process fractures.In the elderly,a slight fall can lead to fracture.In young people,this type of fracture often requires great violence.In recent years,the research on distal radius fracture is increasing.At the same time,patients’ requirements for the treatment effect of distal radius fracture are also increasing.If the treatment is improper,there will be some postoperative complications.Although clinicians’ concepts of treatment and prognosis are constantly updated,we need to be vigilant that there are different complications behind different treatment methods.For patients with extraarticular fractures,closed reduction,plaster fixation and external fixation are the first choice.Intra-articular fractures are more complex.Because the displacement of intra-articular distal radius fractures is usually more than 2mm,and there are usually multiple fracture blocks in the articular surface,surgical treatment is required in most cases.With the development of science and technology,digital imaging technology is more and more used in medicine.When this technology penetrates into the field of orthopedics,it is found that this technology makes the diagnosis and treatment of orthopedic diseases more intuitive,safe and accurate.Up to now,basic research and clinical research related to digital orthopedics are in full swing.With the help of software,we can reconstruct the CT data of the distal radius in three dimensions.The reconstructed three-dimensional image can rotate at any angle and remove the occlusion of specific bone tissue,which is convenient for comprehensive observation and research.This method can break some limitations of preoperative planning and postoperative effect prediction based on traditional X-ray images.This paper is divided into the following aspects to explore its application,in order to provide some new ideas for the diagnosis,treatment and prognosis evaluation of distal radius fractures.Part One Comparative study of the consistency of imaging parameters measured on X-ray image and three-dimensional image of distal radiusObjective: In recent years,with the development of science and technology,digital imaging technology is more and more used in medicine.This study attempts to reconstruct the three-dimensional image of the distal radius with the help of Mimics software,measure the imaging parameters on the three-dimensional image with 3-matic,verify the consistency of the measured indexes such as palmar inclination,ulnar deviation and ulnar variation,and discuss and analyze its clinical application value.Methods: The patients who underwent X-ray examination and CT examination of wrist joint in our hospital from January 2020 to January 2021,including those with distal radius fracture but no obvious displacement and those without distal radius fracture,were included,and their imaging data were collected.Reconstruct the digital three-dimensional model of the distal radius from the documents scanned by CT,adjust and determine the horizontal line or plane of the X-ray image and the three-dimensional reconstruction image.Two orthopedics doctors,as the surveyors,independently measure and record the imaging parameters(palm inclination,ulnar deviation and ulnar variation)when the horizontal axis or plane is determined,so as to calculate the reliability between surveyors.Two weeks later,one of the surveyors measured the imaging parameters of X-ray image and three-dimensional image again to calculate the reliability within the surveyors.For each measurement method,intraclass correlation coefficient(ICC)was used for consistency test to investigate the intra-observer and inter-observer consistency.Results: a total of 20 patients were included in the study.The ICC of palmar inclination angle,ulnar deviation angle and ulnar variation measured in X-ray and three-dimensional images were higher than those measured in X-ray images.The ICC values of palmar inclination,ulnar deviation and ulnar variation were higher than those of the parameters measured in three-dimensional images.Conclusion: Compared with ordinary X-ray images,the measured imaging parameters on three-dimensional images have high consistency.This method changes the two-dimensional angle and distance measurement into three-dimensional space measurement,which is easy to find the key points in the measurement process,and is worthy of popularization and application in clinical work.Part Two Surgical treatment of intra-articular distal radius fractures with the assistance of three-dimensional printing techniqueObjective: The aim of this study was to evaluate the effectiveness and safety of surgical treatment of intra-articular distal radius fractures with the assistance of three-dimensional(3D)printing technique.Methods: Patients with intra-articular DRFs in our hospital from February 2017 to November 2018 were enrolled in this study,and were randomly assigned to two parallel groups to receive surgical treatment with the assistance of 3D printing technique or not.For patients in the 3D printing group,the surgical procedure was simulated with 3D physical model before surgery.Volar plate and K-wire fixation were performed in all patients.Patients in the two groups were compared in terms of intraoperative indexes and postoperative function.Results: A total of 32 patients were included in our study.During surgery,mean operation time in the 3D model group was significantly lower than that in the routine group(P < 0.001).Besides,significantly less blood was lost in the 3D model group than that in the routine group(P < 0.001).Furthermore,the 3D model group had a significantly less times of intraoperative fluoroscopy than that in the routine group(P = 0.002).However,the 3D model group showed no significant difference in VAS score,DASH score or active wrist ROM in comparison with the routine group(P > 0.05).Conclusion: With the assistance of 3D printing technique,the operation time,amount of intraoperative bleeding and times of intraoperative fluoroscopy can be reduced during the surgical treatment of intra-articular DRFs with volar plating and K-wire fixation.This technique is safe and effective,and is worth spreading in other orthopedic surgeries.Part Three Clinical utility of three-dimensional reconstruction images to predict conservative treatment outcomes of intra-articular distal radius fracturesObjective: The three-dimensional images may provide additional information for us,especially in patients with intra-articular distal radius fractures.Our aim was to identify possible risk factors that may be associated with adverse outcomes by use of 3D reconstruction technique.Methods: This study retrospectively reviewed adult patients that underwent plaster immobilization with/without closed reduction for DRFs in our hospital between February 2016 and May 2019.Plaster immobilization with or without additional closed reduction was used for all patients.The 3D reconstruction image of fractured distal radius was looked up from multiple views to determine the existence of gaps or steps,and then a semi-quantitative standard was used to assess the severity of fracture.The patients’ basic data and radiographic data were collected,and multiple linear regression analyses were used to analyze possible risk factors associated with adverse outcomes.Results: A total of 89 cases were analyzed in our study.There are 28,39 and 22 patients with 1,2 and 3 level of fractures respectively based on the semi-quantitative standard.In the multiple linear regression for PRWE,preoperative severity degree(β,0.393;95% CI,0.260-0.526)and postoperative rehabilitation exercise(β,0.352;95% CI,0.023-0.681)were two factors that were associated with the PRWE during follow-up.Conclusion: Our study proposed a new method to assess the severity of intra-articular DRFs which is based on three-dimensional reconstruction images.With the assistance of this method,patients who were regarded as having severe fractures were associated with worse functional outcome.