3D打印技术联合组合式接骨板内固定治疗陈旧性髋臼后壁骨折
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摘要
目的:探讨3D打印技术联合组合式接骨板内固定在治疗陈旧性髋臼后壁骨折中的应用价值及临床疗效。方法:自2010年5月至2016年10月,采用Mimics19.0软件,按1∶1打印骨盆3D模型进行术前规划,同时应用组合式接骨板内固定治疗23例陈旧性髋臼后壁骨折患者,男15例,女8例;年龄20～63(43.0±5.1)岁;受伤至手术时间23～101(47.0±10.5) d。骨折按Letournel-Judet分型:后壁骨折11例,横行伴后壁骨折7例,后柱伴后壁骨折5例;所有患者采用单一Kocher-Langenbeck入路行组合式接骨板内固定,记录术中、术后及随访时观察评定指标。结果:23例患者手术时间(113.5±11.5) min,术中出血(550.0±104.7) ml,术中透视(12.7±0.8) s。采用Matta放射学复位评定标准:优14例,良7例,差2例;23例患者均获得10～24(16.0±5.6)个月随访,末次随访根据改良Merle d’Aubingne和Postel评分系统评定髋关节功能:优11例,良8例,可3例,差1例。术后发生创伤性关节炎3例,股骨头坏死1例,异位骨化2例,坐骨神经刺激征5例。结论:3D打印技术进行术前模拟联合组合式接骨板坚强固定,是一种有效、快捷治疗陈旧性髋臼后壁骨折的手术方法。此外,打印模型能够为术者提供三维立体形态结构,结合术前模拟,便于术中复位,有效提高了手术效率。
Objective:To explore the application value and clinical effect of three-dimensional printing combined with composite plate internal fixation in the treatment of old acetabular posterior wall fracture. Methods : From May 2010 to October 2016,Mimics 19.0 software was used to plan preoperatively according to a 1:1 print pelvic 3D model. At the same time,23 patients with old acetabular posterior wall fractures were treated with combined plate internal fixation, including 15 males and 8 females,aged 20 to 63(43.0±5.1) years old,and the time from injury to operation was 23 to 101(47.0±10.5) days. According to Letournel-Judet classification, 11 cases were posterior wall fracture, 7 cases were transverse with posterior wall fracture, and 5 cases were posterior column with posterior wall fracture. All patients were treated with single Kocher-Langenbeck approach combined plate internal fixation,and the evaluation indexes were recorded during operation, after operation and during follow-up.Results:The operation time of 23 patients was(113.5±11.5) min,bleeding was(550.0±104.7) ml and fluoroscopy was(12.7±0.8) s. Matta radiographic reduction criteria were used excellent in 14 cases,good in 7 cases and poor in 2 cases; 23 patients were followed up for 10 to 24(16.0±5.6) months. The hip function was evaluated according to the modified Merle d'Aubingne and Postal scoring system at the last follow-up :excellent in 11 cases,good in 8 cases,fair in 3 cases and poor in 1 case. There were 3 cases of traumatic arthritis, 1 case of femoral head necrosis, 2 cases of heterotopic ossification and 5 cases of sciatic nerve irritation. Conclusion : 3D printing technique is an effective and fast method for the treatment of old acetabular posterior wall fractures. In addition, the printing model can provide three-dimensional morphological structure for the operator, combined with preoperative simulation, facilitate intraoperative reduction,and effectively improve the efficiency of surgery.
Objective:To explore the application value and clinical effect of three-dimensional printing combined with composite plate internal fixation in the treatment of old acetabular posterior wall fracture. Methods : From May 2010 to October 2016,Mimics 19.0 software was used to plan preoperatively according to a 1:1 print pelvic 3D model. At the same time,23 patients with old acetabular posterior wall fractures were treated with combined plate internal fixation, including 15 males and 8 females,aged 20 to 63(43.0±5.1) years old,and the time from injury to operation was 23 to 101(47.0±10.5) days. According to Letournel-Judet classification, 11 cases were posterior wall fracture, 7 cases were transverse with posterior wall fracture, and 5 cases were posterior column with posterior wall fracture. All patients were treated with single Kocher-Langenbeck approach combined plate internal fixation,and the evaluation indexes were recorded during operation, after operation and during follow-up.Results:The operation time of 23 patients was(113.5±11.5) min,bleeding was(550.0±104.7) ml and fluoroscopy was(12.7±0.8) s. Matta radiographic reduction criteria were used excellent in 14 cases,good in 7 cases and poor in 2 cases; 23 patients were followed up for 10 to 24(16.0±5.6) months. The hip function was evaluated according to the modified Merle d'Aubingne and Postal scoring system at the last follow-up :excellent in 11 cases,good in 8 cases,fair in 3 cases and poor in 1 case. There were 3 cases of traumatic arthritis, 1 case of femoral head necrosis, 2 cases of heterotopic ossification and 5 cases of sciatic nerve irritation. Conclusion : 3D printing technique is an effective and fast method for the treatment of old acetabular posterior wall fractures. In addition, the printing model can provide three-dimensional morphological structure for the operator, combined with preoperative simulation, facilitate intraoperative reduction,and effectively improve the efficiency of surgery.
引文
[1]Jang JH,Moon NH,Park KY.Arthroscopic management of intraarticular screw perforation after surgical treatment of an acetabular posterior wall fracture:a case report[J].Hip Pelvis,2018,30(1):60-64.
[2]王雨辰,马勇,俞伟忠,等.计算机虚拟复位结合3D打印技术在髋臼骨折中的临床应用[J].中国骨伤,2017,30(7):627-632.WANG YC,MA Y,YU WZ,et al.Application of the computer assisten virtual reduction combined with 3D printing technique in acetabular fractures[J].Zhongguo Gu Shang/China J Orthop Trauma,2017,30(7):627-632.Chinese with abstract in English.
[3]Wu X.A biomechanical comparison of different fixation techniques for fractures of the acetabularposterior wall[J].Int Orthop,2018,42(3):673-679.
[4]Deng C,Ni WD,Guo SQ,et al.Operative treatment of delayed acetabular fractures through combined anterior and Kocher Langenbeck approaches[J].Zhonghua Wai Ke Za Zhi,2018,56(3):196-200.
[5]Trauner KB.The Emerging Role of 3D Printing in Arthroplasty and Orthopedics[J].J Arthroplasty,2018,33(8):2352-2354.
[6]Goulet JA,Rouleau JP,Mason DJ,et al.Comminuted fractures of the posterior wall of the acetabulum.A biomechanical evaluation of fixation methods[J].J Bone Joint Surg Am,1994,76(10):1457-1463.
[7]潘昌武,蔡贤华,刘曦明,等.微型接骨板联合重建钢板与螺钉联合重建接骨板治疗髋臼后壁骨折的疗效比较[J].中华创伤骨科杂志,2015,17(5):374-378.PAN CW,CAI XH,LIU XM,et al.Mini plate plus reconstruction plate versus screws plus reconstruction plate for fractures of acetabular posterior wall[J].Zhonghua Chuang Shang Gu Ke Za Zhi,2015,17(5):374-378.Chinese.
[8]Judet R,Judet J,Letournel E.Fractures of the acetabulum:classification and surgical approaches for open reduction.Preliminary report[J].J Bone Joint Surg Am,1964,46:1615-1646.
[9]Matta JM.Fractures of the acetabulum:accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury[J].J Bone Joint Surg Am,1996,78(11):1632-1645.
[10]d’AubignéRM,Postel M.The classic functional results of hip arthroplasty with acrylic prosthesis[J].Clin Orthop Relat Res,2009,467:7-27.
[11]Cahueque M,Martinez M,Cobar A,et al.Early reduction of acetabular fractures decreases the risk of post traumatic hip osteoarthritis[J].J Clin Orthop Trauma,2017,8(4):320-326.
[12]王海滨,吴彬,随萍,等.切开复位内固定治疗陈旧性髋臼骨折的疗效分析[J].中华创伤杂志,2016,32(8):695-700.WANG HB,WU B,SUI P,et al.Efficacy analysis of open reduction and internal fixation for treatment of delayed acetabular fractures[J].Zhonghua Chuang Shang Za Zhi,2016,32(8):695-700.Chinese.
[13]彭烨,张立海,唐佩福.髋臼方形区骨折的治疗及研究进展[J].中国骨伤,2015,28(5):472-475.PENG Y,ZHANG LH,TANG PF.Progress on treatment and research of quadrilateral plate fractures of acetabular[J].Zhongguo Gu Shang/China J Orthop Trauma,2015,28(5):472-475.Chinese with abstract in English..
[14]王锋,汪国栋,Chao Xie,等.3D打印技术在髋臼后壁骨折手术治疗中的应用[J].中华创伤骨科杂志,2016,18(2):120-125.WANG F,WANG GD,CHAO X,et al.Application of 3D printing technology in treatment of acetabular posterior wall fractures[J].Zhonghua Chuang Shang Gu Ke Za Zhi,2016,18(2):120-125.Chinese.
[15]Tillander B,Ledin T,Nordqvist P,et al.A virtual reality trauma simulator[J].Med Teach,2004,26(2):189-191.
[16]杨鹏,叶添文,张帆,等.3D打印技术辅助手术治疗骶骨骨折伴骶丛神经损伤[J].中华创伤骨科杂志,2015,17(1):13-17.YANG P,YE TW,ZHANG F,et al.Surgical treatment of sacral fractures accompanied with lumbosacral plexus avulsion assisted by3D printing[J].Zhonghua Chuang Shang Gu Ke Za Zhi,2015,17(1):13-17.Chinese.
[17]Weaver MJ,Smith RM,Lhowe DW,et al.Does total hip arthroplasty reduce the risk of secondary surgery following the treatment of displaced acetabular fractures in the elderly compared to open reduction internal fixation?A pilot study[J].J Orthop Trauma,2018,32(Suppl 1):S40-S45.
[18]Johnson EE,Matta JM,Mast JW,et al.Delayed reconstruction of acetabular fracture 21 120 days following injury[J].Clin Orthop Relat Res,1994,(305):20-30.
[19]杨永良,周东生,李连欣,等.腹主动脉球囊阻断术在陈旧性髋臼骨折治疗中的应用[J].中华创伤骨科杂志,2012,14(5):376-380.YANG YL,ZHOU DS,LI LX,et al.Temporary balloon occlusion of the abdominal aorta during open reduction and internal fixation of delayed acetabular fractures[J].Zhonghua Chuang Shang Gu Ke Za Zhi,2012,14(5):376-380.Chinese.
[20]Laird A,Keating JF.Acetabular fractures:a 16 years prospective epidemiological study[J].J Bone Joint Surg Br,2005,87(7):969-973.
[21]Khira YM,El Aidy S.Surgical treatment of marginal osteochondral impaction in acetabular fractures[J].Musculoskelet Surg,2018,102(2):139-145.
[2]王雨辰,马勇,俞伟忠,等.计算机虚拟复位结合3D打印技术在髋臼骨折中的临床应用[J].中国骨伤,2017,30(7):627-632.WANG YC,MA Y,YU WZ,et al.Application of the computer assisten virtual reduction combined with 3D printing technique in acetabular fractures[J].Zhongguo Gu Shang/China J Orthop Trauma,2017,30(7):627-632.Chinese with abstract in English.
[3]Wu X.A biomechanical comparison of different fixation techniques for fractures of the acetabularposterior wall[J].Int Orthop,2018,42(3):673-679.
[4]Deng C,Ni WD,Guo SQ,et al.Operative treatment of delayed acetabular fractures through combined anterior and Kocher Langenbeck approaches[J].Zhonghua Wai Ke Za Zhi,2018,56(3):196-200.
[5]Trauner KB.The Emerging Role of 3D Printing in Arthroplasty and Orthopedics[J].J Arthroplasty,2018,33(8):2352-2354.
[6]Goulet JA,Rouleau JP,Mason DJ,et al.Comminuted fractures of the posterior wall of the acetabulum.A biomechanical evaluation of fixation methods[J].J Bone Joint Surg Am,1994,76(10):1457-1463.
[7]潘昌武,蔡贤华,刘曦明,等.微型接骨板联合重建钢板与螺钉联合重建接骨板治疗髋臼后壁骨折的疗效比较[J].中华创伤骨科杂志,2015,17(5):374-378.PAN CW,CAI XH,LIU XM,et al.Mini plate plus reconstruction plate versus screws plus reconstruction plate for fractures of acetabular posterior wall[J].Zhonghua Chuang Shang Gu Ke Za Zhi,2015,17(5):374-378.Chinese.
[8]Judet R,Judet J,Letournel E.Fractures of the acetabulum:classification and surgical approaches for open reduction.Preliminary report[J].J Bone Joint Surg Am,1964,46:1615-1646.
[9]Matta JM.Fractures of the acetabulum:accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury[J].J Bone Joint Surg Am,1996,78(11):1632-1645.
[10]d’AubignéRM,Postel M.The classic functional results of hip arthroplasty with acrylic prosthesis[J].Clin Orthop Relat Res,2009,467:7-27.
[11]Cahueque M,Martinez M,Cobar A,et al.Early reduction of acetabular fractures decreases the risk of post traumatic hip osteoarthritis[J].J Clin Orthop Trauma,2017,8(4):320-326.
[12]王海滨,吴彬,随萍,等.切开复位内固定治疗陈旧性髋臼骨折的疗效分析[J].中华创伤杂志,2016,32(8):695-700.WANG HB,WU B,SUI P,et al.Efficacy analysis of open reduction and internal fixation for treatment of delayed acetabular fractures[J].Zhonghua Chuang Shang Za Zhi,2016,32(8):695-700.Chinese.
[13]彭烨,张立海,唐佩福.髋臼方形区骨折的治疗及研究进展[J].中国骨伤,2015,28(5):472-475.PENG Y,ZHANG LH,TANG PF.Progress on treatment and research of quadrilateral plate fractures of acetabular[J].Zhongguo Gu Shang/China J Orthop Trauma,2015,28(5):472-475.Chinese with abstract in English..
[14]王锋,汪国栋,Chao Xie,等.3D打印技术在髋臼后壁骨折手术治疗中的应用[J].中华创伤骨科杂志,2016,18(2):120-125.WANG F,WANG GD,CHAO X,et al.Application of 3D printing technology in treatment of acetabular posterior wall fractures[J].Zhonghua Chuang Shang Gu Ke Za Zhi,2016,18(2):120-125.Chinese.
[15]Tillander B,Ledin T,Nordqvist P,et al.A virtual reality trauma simulator[J].Med Teach,2004,26(2):189-191.
[16]杨鹏,叶添文,张帆,等.3D打印技术辅助手术治疗骶骨骨折伴骶丛神经损伤[J].中华创伤骨科杂志,2015,17(1):13-17.YANG P,YE TW,ZHANG F,et al.Surgical treatment of sacral fractures accompanied with lumbosacral plexus avulsion assisted by3D printing[J].Zhonghua Chuang Shang Gu Ke Za Zhi,2015,17(1):13-17.Chinese.
[17]Weaver MJ,Smith RM,Lhowe DW,et al.Does total hip arthroplasty reduce the risk of secondary surgery following the treatment of displaced acetabular fractures in the elderly compared to open reduction internal fixation?A pilot study[J].J Orthop Trauma,2018,32(Suppl 1):S40-S45.
[18]Johnson EE,Matta JM,Mast JW,et al.Delayed reconstruction of acetabular fracture 21 120 days following injury[J].Clin Orthop Relat Res,1994,(305):20-30.
[19]杨永良,周东生,李连欣,等.腹主动脉球囊阻断术在陈旧性髋臼骨折治疗中的应用[J].中华创伤骨科杂志,2012,14(5):376-380.YANG YL,ZHOU DS,LI LX,et al.Temporary balloon occlusion of the abdominal aorta during open reduction and internal fixation of delayed acetabular fractures[J].Zhonghua Chuang Shang Gu Ke Za Zhi,2012,14(5):376-380.Chinese.
[20]Laird A,Keating JF.Acetabular fractures:a 16 years prospective epidemiological study[J].J Bone Joint Surg Br,2005,87(7):969-973.
[21]Khira YM,El Aidy S.Surgical treatment of marginal osteochondral impaction in acetabular fractures[J].Musculoskelet Surg,2018,102(2):139-145.
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