1.Eastern Air Force Hospital;2.Eastern Air Force Hospital,;3.Nanjing Yuhua Hospital
摘要： 目的 ：利用壁厚分析法三维定量判断胫骨骨愈合程度，为临床判断胫骨“骨不连”和“骨延迟愈合”提供一个直观的诊断依据。 方法：选取2013年4月至2018年10月，我院临床诊断“骨不连”和“骨延迟愈合”的患者48例。所有患者随访2年到4年，在骨愈合的不同阶段多次进行CT检查，导出DICOM数据，并且采用MIMICS软件，对患者患侧与健侧的网格模型的最大壁厚分值进行比值计算，其对比值作为骨愈合程度的量化指标全程动态观察， 对于临床诊断进行二次修正，并观察最终临床愈合结果。 结果：对48例患者各复查时间段影像学进行临床诊断分析及有限元壁厚分析比较，临床判断骨延迟愈合21例，骨不连27例，再利用壁厚分析修正判断，骨延迟愈合34例，骨不连14例。其中2例判断内置物失效，采用更换内固定植骨干预，12例判断内固定仍然有效，单纯植骨手术干预，所有病例最终都取得骨愈合。进行Bowker检验法得到P=0.094（P>0.05），判断壁厚分析方法与临床诊断相符合。 结论： 骨愈合是骨的结构和生物力学特性的恢复过程，动态和定量的方式判断骨愈合程度是临床工作的需要。采用有限元分析分析法的技术，可以定量的分析骨折端的骨愈合程度，实现骨愈合程度的快速计算，本组病例结果证实有限元壁厚分析法优于单纯临床诊断法，对早期判断骨愈合不良有更好的鉴别诊断意义。
Objective To quantitatively judge the degree of tibial bone healing with the finite element wall thickness analysis, and to provide an intuitive diagnostic basis for clinical judgment of tibial "union" and "bone delayed healing". Methods 48 patients with clinical diagnosis of "union of bone" and "delayed healing of bone" were selected in our hospital from April 2013 to October 2018. All patients were followed up for 2 to 4 years. CT examinations were performed at different stages of bone healing, DICOM data was exported, and the maximum wall thickness score of the mesh model of the affected limb and the healthy limb was calculated by MIMICS software. The contrast value was used as a quantitative indicator of the degree of bone healing. The clinical diagnosis was conducted a second correction and the final clinical healing results were observed. Results Clinical diagnosis analysis and finite element wall thickness analysis were carried out in 48 patients during each review period, and 21 cases of delayed bone healing and 27 cases of bone nonunion were judged clinically.Among them, 2 cases were judged to be ineffective, and bone grafting intervention was adopted to replace the internal fixation, 12 cases were judged to be still effective, and all cases were finally healed by the surgical intervention of bone grafting alone.By Bowker test, P=0.094 (P>0.05) was obtained, and the wall thickness analysis method was consistent with the clinical diagnosis. Conclusion Bone healing is the recovery process of bone structure and biomechanical properties. It is the need of clinical work to dynamically and quantitatively judge the degree of bone healing. The degree of bone healing can be quantitatively analyzed and be quickly achieved with the technique of finite element analysis. The results of this group of cases confirm that the finite element wall thickness is superior to the simple clinical diagnosis method and has a better differential diagnosis value for early judgment of poor bone healing.