3D打印联合Minmics软件在肘关节骨折中的应用
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摘要
目的探讨3D打印联合Minmics软件在肘关节骨折中的应用。方法 20例肘关节骨折的患者,随机分为3D打印联合Minmics软件组和常规手术组,每组10例。3D打印联合Minmics软件组精确打印骨折局部,了解断端情况,用Minmics软件模拟复位和固定,确定手术方案。常规手术组根据影像学资料确定手术方案。比较两组之间切口长度、出血量、手术时间、透视次数、住院时间、术后Mayo评分和肘关节活动度。结果两组在切口长度[(13. 1±1. 65) cm vs(13. 9±1. 27) cm]和住院时间[(14. 7±0. 6) d vs (15. 1±1. 1) d]方面差异无统计学意义(P> 0. 05),而在出血量[(153. 3±23. 9) ml vs (246. 3±34. 7) ml],手术时间[(2. 1±0. 3) h vs (2. 9±0. 4) h],透视次数[(8. 7±1. 6)次vs (11. 1±1. 2)次]方面差异有统计学意义(P <0. 05)。两组在术后3个月、6个月、12个月Mayo评分较术前显著增加,差异有统计学意义(P <0. 05)。术后各个时间点3D打印联合Minmics软件组Mayo评分均显著高于常规手术组。术后12个月3D打印联合Minmics软件组在肘关节屈曲(120. 7°±3. 2°vs 104. 5°±4. 6°)、伸直(9. 4°±3. 1°vs 17. 3°±2. 79°)、旋前(73. 6°±2. 9°vs 64. 3°±4. 2°)、旋后(76. 4°±2. 1°vs67. 2°±3. 3°)方面显著优于常规手术组,差异有统计学意义(P <0. 05)。结论 3D打印联合Minmics软件可以因人而异制定个体化的手术方案,可以缩短手术时间,减少出血量,降低透视次数,提高术后肘关节功能的恢复,值得临床推广应用。
Objective To explore the application of 3 D printing combined with Minmics software in the elbow fracture. Methods Twenty patients with elbow fracture were randomly divided into 3 D printing combined with Minmics software group and routine operation group( n = 10 each group). The fracture part was accurately printed in 3 D printing combined with Minmics software group to understand the situation of the broken end,simulate reduction and fixation by the Minmics software,and then determine the operation plan. The operation plan was made according to the imaging data in routine operation group. The incision length,bleeding volume,operation time,fluoroscopy times,hospital stays,Mayo score and elbow motion were compared between the two groups. Results There was no statistical difference in incision length[( 13. 1 ±1. 65) cm vs( 13. 9 ±1. 27) cm]and hospital stays[( 14. 7 ±0. 6) d vs( 15. 1 ±1. 1) d]between the two groups,but there was statistical difference in bleeding volume [( 153. 3 ±23. 9) ml vs( 246. 3 ±34. 7) ml,P < 0. 05],operation time[( 2. 1 ±0. 3) h vs( 2. 9 ±0. 4) h,P < 0. 05] and fluoroscopy times( 8. 7 ±1. 6 vs 11. 1 ±1. 2,P < 0. 05). Mayo score significantly increased in the two groups 3 months,6 months and 12 months after operation. Compared to routine group,Mayo score in 3 D printing combined with Minmics software group was higher than that in routine group at each time point after operation. The function of elbow motion at aspects of flexion( 120. 7°±3. 2° vs 104. 5°±4. 6°),straight( 9. 4°±3. 1° vs 17. 3°±2. 79°),pronation( 73. 6°±2. 9° vs64. 3°±4. 2°) and supination( 76. 4°±2. 1° vs 67. 2°±3. 3°) were better in 3 D printing combined with Minmics software group than in routine group 12 months after operation. Conclusion The 3 D printing combined with Minmics software can make an individualized operation plan according to different subjects. It can shorten the operation time,reduce the amount of bleeding,reduce the number of fluoroscopy,and improve the elbow function after operation. It is worthy of clinical application.
Objective To explore the application of 3 D printing combined with Minmics software in the elbow fracture. Methods Twenty patients with elbow fracture were randomly divided into 3 D printing combined with Minmics software group and routine operation group( n = 10 each group). The fracture part was accurately printed in 3 D printing combined with Minmics software group to understand the situation of the broken end,simulate reduction and fixation by the Minmics software,and then determine the operation plan. The operation plan was made according to the imaging data in routine operation group. The incision length,bleeding volume,operation time,fluoroscopy times,hospital stays,Mayo score and elbow motion were compared between the two groups. Results There was no statistical difference in incision length[( 13. 1 ±1. 65) cm vs( 13. 9 ±1. 27) cm]and hospital stays[( 14. 7 ±0. 6) d vs( 15. 1 ±1. 1) d]between the two groups,but there was statistical difference in bleeding volume [( 153. 3 ±23. 9) ml vs( 246. 3 ±34. 7) ml,P < 0. 05],operation time[( 2. 1 ±0. 3) h vs( 2. 9 ±0. 4) h,P < 0. 05] and fluoroscopy times( 8. 7 ±1. 6 vs 11. 1 ±1. 2,P < 0. 05). Mayo score significantly increased in the two groups 3 months,6 months and 12 months after operation. Compared to routine group,Mayo score in 3 D printing combined with Minmics software group was higher than that in routine group at each time point after operation. The function of elbow motion at aspects of flexion( 120. 7°±3. 2° vs 104. 5°±4. 6°),straight( 9. 4°±3. 1° vs 17. 3°±2. 79°),pronation( 73. 6°±2. 9° vs64. 3°±4. 2°) and supination( 76. 4°±2. 1° vs 67. 2°±3. 3°) were better in 3 D printing combined with Minmics software group than in routine group 12 months after operation. Conclusion The 3 D printing combined with Minmics software can make an individualized operation plan according to different subjects. It can shorten the operation time,reduce the amount of bleeding,reduce the number of fluoroscopy,and improve the elbow function after operation. It is worthy of clinical application.
引文
[1]李涛,周谋望,侯树勋,等.肘关节骨折患者康复模式的前瞻性多中心研究[J].中国骨与关节杂志,2016,5(4):261-266.
[2]石秀秀,唐金树,吴新宝,等.肘关节骨折术后功能恢复的影响因素[J].中国骨与关节杂志,2016,5(3):188-193.
[3]张杰,刘洋波,李义刚,等.复杂肘关节骨折脱位的个性化治疗[J].检验医学与临床,2015,12(11):1606-1607.
[4]姬文晨,蒋婉婷,李志强,等. 3D打印结合PBL在骨科住院医师规范化培训中的应用[J].中国医学教育技术,2017,31(1):64-67.
[5]王德伟,赵英伟. 3D打印技术在骨盆骨折诊疗中应用进展[J].创伤外科杂志,2018,20(1):77-80.
[6]柳鑫,曾参军,卢键森,等. 3D打印计算机虚拟辅助技术在髋臼骨折术前规划中的应用[J].南方医科大学学报,2017,37(3):378-382.
[7]姬文晨,蒋婉婷,李嘉,等.数字骨科技术辅助MIPPO在治疗胫腓骨近端粉碎性骨折中的作用[J].山西医科大学学报,2018,49(4):426-430.
[8]穆臣会,郭氧,卓爱国,等.锚钉固定治疗肘关节内侧副韧带复合体损伤的疗效分析[J].实用骨科杂志,2017,23(12):1120-1122.
[9]黄丰,郭春云,孙永建,等.肘关节骨折术后早期康复治疗对功能恢复的影响[J].中外医学研究,2018,16(16):107-109.
[10]赵海军,申成凯.外固定架与传统固定法对骨科创伤肘关节功能的影响[J].中外医疗,2017,36(10):4-6.
[11]章晓云,夏天,陈跃平,等.尺骨冠状突骨折复位固定对肘关节骨折脱位术后肘关节稳定的意义[J].中国骨与关节损伤杂志,2017,32(5):487-489.
[12]衡立松,朱养均,张堃,等.内固定结合铰链式外固定支架治疗复杂肘关节骨折[J].创伤外科杂志,2017,19(7):492-495.
[13]张权,陈文钧,王世龙,等.肘关节骨折脱位的稳定性渐次评估与修复[J].中国骨与关节杂志,2016,5(4):251-255.
[14]赵昕,王金成,张汉阳,等. 3D打印技术在类风湿关节炎肘关节置换中的临床应用[J].中国地方病防治杂志,2018,33(1):79-81.
[15]马旭,邬波,柳椰,等. 3D打印技术在肘关节骨折治疗中的应用[J].中华骨与关节外科杂志,2017,10(3):228-231.
[16]阳宏奇,雷青,蔡立宏,等. 3D打印导板辅助空心螺钉内固定治疗不稳定性骨盆骨折[J].中国修复重建外科杂志,2018,32(2):145-151.
[2]石秀秀,唐金树,吴新宝,等.肘关节骨折术后功能恢复的影响因素[J].中国骨与关节杂志,2016,5(3):188-193.
[3]张杰,刘洋波,李义刚,等.复杂肘关节骨折脱位的个性化治疗[J].检验医学与临床,2015,12(11):1606-1607.
[4]姬文晨,蒋婉婷,李志强,等. 3D打印结合PBL在骨科住院医师规范化培训中的应用[J].中国医学教育技术,2017,31(1):64-67.
[5]王德伟,赵英伟. 3D打印技术在骨盆骨折诊疗中应用进展[J].创伤外科杂志,2018,20(1):77-80.
[6]柳鑫,曾参军,卢键森,等. 3D打印计算机虚拟辅助技术在髋臼骨折术前规划中的应用[J].南方医科大学学报,2017,37(3):378-382.
[7]姬文晨,蒋婉婷,李嘉,等.数字骨科技术辅助MIPPO在治疗胫腓骨近端粉碎性骨折中的作用[J].山西医科大学学报,2018,49(4):426-430.
[8]穆臣会,郭氧,卓爱国,等.锚钉固定治疗肘关节内侧副韧带复合体损伤的疗效分析[J].实用骨科杂志,2017,23(12):1120-1122.
[9]黄丰,郭春云,孙永建,等.肘关节骨折术后早期康复治疗对功能恢复的影响[J].中外医学研究,2018,16(16):107-109.
[10]赵海军,申成凯.外固定架与传统固定法对骨科创伤肘关节功能的影响[J].中外医疗,2017,36(10):4-6.
[11]章晓云,夏天,陈跃平,等.尺骨冠状突骨折复位固定对肘关节骨折脱位术后肘关节稳定的意义[J].中国骨与关节损伤杂志,2017,32(5):487-489.
[12]衡立松,朱养均,张堃,等.内固定结合铰链式外固定支架治疗复杂肘关节骨折[J].创伤外科杂志,2017,19(7):492-495.
[13]张权,陈文钧,王世龙,等.肘关节骨折脱位的稳定性渐次评估与修复[J].中国骨与关节杂志,2016,5(4):251-255.
[14]赵昕,王金成,张汉阳,等. 3D打印技术在类风湿关节炎肘关节置换中的临床应用[J].中国地方病防治杂志,2018,33(1):79-81.
[15]马旭,邬波,柳椰,等. 3D打印技术在肘关节骨折治疗中的应用[J].中华骨与关节外科杂志,2017,10(3):228-231.
[16]阳宏奇,雷青,蔡立宏,等. 3D打印导板辅助空心螺钉内固定治疗不稳定性骨盆骨折[J].中国修复重建外科杂志,2018,32(2):145-151.