3D打印技术在陈旧性骨盆髋臼骨折治疗中的应用
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摘要
[目的]比较3D打印技术辅助与传统开放复位内固定治疗陈旧性骨盆髋臼骨折的临床疗效。[方法] 36例陈旧性骨盆髋臼骨折患者,随机分为3D组与常规组,每组18例。3D组常规行螺旋CT扫描并复制重建CT数据,通过3D打印技术制作1:1实物模型,设计手术方案并在模型上进行"预手术",完成骨折断端的截骨、骨盆髋臼的矫形及复位内固定术,标记塑形所需的固定钢板、螺钉的方向及角度,应用于实际手术操作中。常规组常规行骨盆髋臼X线片及CT三维重建,结合手术医师的临床经验完成内固定术。[结果] 3D组手术时间、术中出血量、术后引流量均显著少于常规组,差异具有统计学意义(P<0.05)。按Matta影像学标准,骨折复位质量3D组优14例,良2例,可2例,优良率88.89%;常规组优7例,良6例,可5例,优良率72.22%,差异有统计学意义(P<0.05);末次随访时,3D组改良的Merle D'Aubigné和Postel评分为(16.00±1.94)分,常规组为(14.61±2.09)分,差异具有统计学意义(P<0.05)。[结论] 3D打印技术辅助治疗陈旧性骨盆髋臼骨折有助于术者了解骨折特点并在术前制定优化、精确的个性化手术方案,提高手术的安全性及精准复位,缩短手术时间,减少术后并发症的发生,提高临床疗效。
[objective] To compare the clinical outcomes of three-dimensions printing(3 D-printing) assisted versus conventional open reduction and internal fixation(ORIF) for old pelvic and acetabular fractures. [Method] Thirty-six patients with old pelvic and acetabular fractures were randomly divided into the 3 D group and the conventional group, with 18 patients in each group. The patients in the 3 D had ORIF conducted after surgery simulation, including approach selection, fracture reduction,proper selection and pre-shaping of implants, direction and dimension of screws placed, was conducted on a 1:1 real pelvic mode, which was made by 3 D-printing technique based on preoperative CT scanning of the pelvis. However, the patients in the conventional group received a routine ORIF based on conventional imaging data and surgeons'experience. [Results] The 3 D group proved significantly shorter operation time, less intraoperative blood loss and postoperative drainage volume than the conventional group, which all were statistically significant(P<0.05). In term of Matta's radiographic criteria, the quality of fracture reduction was graded as excellent in 14, good in 2 and fair in 2 cases with the excellent and good rate of 88.89% in the 3 D group, whereas excellent in 7, good in 6 and fair in 6 cases with the excellent and good rate of 72.22% in the conventional group, there was a statistically significant difference between the two groups(P<0.05). At the latest follow-up, the modified Merle D'Aubigné and Postel score proved(16.00±1.94) in the 3 D group, while(14.61±2.09) in the conventional group, which was statistically significant(P<0.05). [Conclusion] The 3 D printing technique does facilitate the surgeon to understand the characteristics of the fracture, develop a more optimized and accurate operative plan, as well as improve the safety of the operation and enhance the clinical outcomes for old pelvic and acetabular fractures.
[objective] To compare the clinical outcomes of three-dimensions printing(3 D-printing) assisted versus conventional open reduction and internal fixation(ORIF) for old pelvic and acetabular fractures. [Method] Thirty-six patients with old pelvic and acetabular fractures were randomly divided into the 3 D group and the conventional group, with 18 patients in each group. The patients in the 3 D had ORIF conducted after surgery simulation, including approach selection, fracture reduction,proper selection and pre-shaping of implants, direction and dimension of screws placed, was conducted on a 1:1 real pelvic mode, which was made by 3 D-printing technique based on preoperative CT scanning of the pelvis. However, the patients in the conventional group received a routine ORIF based on conventional imaging data and surgeons'experience. [Results] The 3 D group proved significantly shorter operation time, less intraoperative blood loss and postoperative drainage volume than the conventional group, which all were statistically significant(P<0.05). In term of Matta's radiographic criteria, the quality of fracture reduction was graded as excellent in 14, good in 2 and fair in 2 cases with the excellent and good rate of 88.89% in the 3 D group, whereas excellent in 7, good in 6 and fair in 6 cases with the excellent and good rate of 72.22% in the conventional group, there was a statistically significant difference between the two groups(P<0.05). At the latest follow-up, the modified Merle D'Aubigné and Postel score proved(16.00±1.94) in the 3 D group, while(14.61±2.09) in the conventional group, which was statistically significant(P<0.05). [Conclusion] The 3 D printing technique does facilitate the surgeon to understand the characteristics of the fracture, develop a more optimized and accurate operative plan, as well as improve the safety of the operation and enhance the clinical outcomes for old pelvic and acetabular fractures.
引文
[1]陆俭军,秦豪,陆声榆,等. 3D打印技术在髋臼骨折手术中的应用[J].右江医学, 2016, 44(5):506-509.
[2]李振宏.髋臼骨折的治疗现状与进展[J].广西医学, 2017, 6(39):880-884.
[3]孙玉强,金东旭,唐明杰,等.髋臼双柱骨折的手术治疗[J].中国创伤骨科杂志, 2008, 10(12):1116-1120.
[4] Johnson EE, Matta JM, Most JW, et al. Delayed reconstruction of acetabular fracture[J]. Clin Orthop, 1994, 305:20-30.
[5]王朝晖,刘华武,何波涌,等.改良Stoppa入路死亡冠血管的解剖学研究[J].中国骨与关节损伤杂志, 2014, 8(3):748-750.
[6] Okcu G, Erkan S, Yerkan H S, et al. The incidence and location of corona mortis:a study on 75 cadavers[J]. Acta Orthop Scand,2004, 75(1):53-55.
[7]陈开放,段德胜,熊泽康,等. 3D打印技术辅助高位髂腹股沟入路治疗复杂髋臼骨折[J].中华骨科杂志, 2017, 37(13):786-792.
[8]吴新宝.利用3D打印技术辅助治疗陈旧性骨盆骨折[J].中华创伤骨科杂志, 2017, 6(39):880-884.
[9]曾参军,谭新宇,黄华军,等.基于3D打印的腹直肌旁切口治疗骨盆骨折的临床疗效[J].南方医科大学学报, 2016, 36(22):220-225.
[10]游景扬,王刚,郑勇,等.复杂髋臼骨折手术疗效的影响因素分析[J].中国骨与关节损伤杂志, 2012, 27(10):873-875.
[11]熊进,陈一心,王骏飞,等.复杂髋臼骨折的手术治疗[J].临床骨科杂志, 2010, 13(4):375-377.
[12]王扬生,黄鑫,王福生,等.手术治疗51例髋臼骨折[J].临床骨科杂志, 2011, 14(4):386-388.
[13] Bagaria V, Deshpande S, Rasalkar DD, et al. Use of rapid prototyping and three-dimensional reconstruction modeling in the management of complex fractures[J]. Eu J Radio, 2011, 80(3):814-820.
[2]李振宏.髋臼骨折的治疗现状与进展[J].广西医学, 2017, 6(39):880-884.
[3]孙玉强,金东旭,唐明杰,等.髋臼双柱骨折的手术治疗[J].中国创伤骨科杂志, 2008, 10(12):1116-1120.
[4] Johnson EE, Matta JM, Most JW, et al. Delayed reconstruction of acetabular fracture[J]. Clin Orthop, 1994, 305:20-30.
[5]王朝晖,刘华武,何波涌,等.改良Stoppa入路死亡冠血管的解剖学研究[J].中国骨与关节损伤杂志, 2014, 8(3):748-750.
[6] Okcu G, Erkan S, Yerkan H S, et al. The incidence and location of corona mortis:a study on 75 cadavers[J]. Acta Orthop Scand,2004, 75(1):53-55.
[7]陈开放,段德胜,熊泽康,等. 3D打印技术辅助高位髂腹股沟入路治疗复杂髋臼骨折[J].中华骨科杂志, 2017, 37(13):786-792.
[8]吴新宝.利用3D打印技术辅助治疗陈旧性骨盆骨折[J].中华创伤骨科杂志, 2017, 6(39):880-884.
[9]曾参军,谭新宇,黄华军,等.基于3D打印的腹直肌旁切口治疗骨盆骨折的临床疗效[J].南方医科大学学报, 2016, 36(22):220-225.
[10]游景扬,王刚,郑勇,等.复杂髋臼骨折手术疗效的影响因素分析[J].中国骨与关节损伤杂志, 2012, 27(10):873-875.
[11]熊进,陈一心,王骏飞,等.复杂髋臼骨折的手术治疗[J].临床骨科杂志, 2010, 13(4):375-377.
[12]王扬生,黄鑫,王福生,等.手术治疗51例髋臼骨折[J].临床骨科杂志, 2011, 14(4):386-388.
[13] Bagaria V, Deshpande S, Rasalkar DD, et al. Use of rapid prototyping and three-dimensional reconstruction modeling in the management of complex fractures[J]. Eu J Radio, 2011, 80(3):814-820.