关键词: Pilon骨折, 3D骨折地图, 骨折分型, 配准, 3D重建, 手术规划, 效能评估

Abstract: Objective  To explore the clinical value of three-dimensional (3D) fracture mapping in improving the consistency of Arbeitsgemeinschaft für Osteosynthesefragen (AO)/the Orthopaedic Trauma Association (OTA) classification and optimizing preoperative surgical planning for Pilon fractures. Methods  This single-center retrospective cohort study included 60 Pilon fracture patients admitted to the Trauma Emergency Center of the Third Hospital of Hebei Medical University between January 2022 and December 2024. All patients underwent preoperative computed tomography (CT) scans. Image standardization and expert manual segmentation/annotation of fracture lines and fragments were performed with 3D Slicer software. 3D fracture lines extracted from gold-standard models were registered to a unified standard tibial model. A 3D probability heatmap was constructed by counting spatial fracture frequency, with high-incidence zones analyzed via spatial clustering algorithms. Three orthopedic surgeons independently completed AO/OTA classification and preoperative planning with the assistance of  conventional CT only and CT with 3D fracture mapping. Accuracy, time consumption, inter-observer consistency (Cohen's κ), planning time, plan modification frequency, and subjective scores were evaluated. Results  The 3D fracture heatmap revealed that fracture lines predominantly concentrated in the anterolateral and posteromedial regions of the distal tibia, with an average of (4. 2±1. 1) hotspots, a coverage rate of (78. 3±5. 6)%, and (3. 5±1. 0) clustering areas. With 3D fracture mapping assistance, classification accuracy was improved to (88. 0±5. 0)% compared to (75. 0±8. 0)% with conventional CT (P=0. 001); classification time reduced to (10. 4±2. 5) min from (15. 2±3. 1) min (P<0. 001); and Cohen's κ increased from 0. 68±0. 05 to 0. 82±0. 03 (P=0. 002). For preoperative planning, the average planning time was (15. 8±3. 2) min in the 3D mapping-assisted group,  which was significantly shorter than that of conventional CT group (22. 5±4. 3) min (P<0. 001); the number of plan modifications was (1. 5±0. 7) times, lower than that of conventional CT group (3. 2±1. 1 ) times (P<0. 001), and the  subjective score was 8. 9±0. 9, higher than that of conventional CT group (6. 8±1. 2) (P<0. 001). Conclusion  The 3D fracture mapping accurately characterizes spatial distribution patterns of Pilon fractures, significantly improves classification accuracy, inter-observer consistency, and preoperative planning efficiency, and thus holds substantial clinical value.

Key words: Pilon fracture, 3D fracture map, fracture typing, registration, 3D reconstruction, surgical planning, efficacy evaluation