3D打印技术在四肢近关节骨折治疗中的应用研究
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摘要
目的:探讨3D打印技术辅助手术治疗四肢近关节部位骨折患者的临床效果与价值。方法:选取2015年6月-2016年3月本院接受四肢近关节骨折治疗的患者62例。按照不同手术方式将其分为对照组(常规手术)32例和研究组(3D打印技术辅助手术)30例。比较两组手术时间、术中出血量、术后骨折愈合时间、愈合后的不良情况,比较术后6、12、18个月的关节功能恢复评分。结果:研究组平均手术时间(58.6±16.3)min、术中平均出血量(101.68±23.59)mL、平均骨折愈合时间(9.6±2.1)个月,均少于对照组的(72.3±12.6)min、(135.33±18.67)mL、(13.7±2.6)个月,比较差异均有统计学意义(t=-3.716、-6.248、-6.803,P=0.000、0.000、0.000);两组患者均Ⅰ期愈合,术后无感染并发症状,研究组愈合后无疼痛,对照组愈合后出现轻度间歇性疼痛2例,保养护理3个月后消失,两组愈合后的不良情况比较,差异无统计学意义(P>0.05);术后6、12、18个月,研究组关节功能评分均高于对照组,比较差异均有统计学意义(P<0.05)。结论:利用3D打印技术辅助手术治疗四肢近关节部位骨折患者,可帮助术者做出明确的术前诊断、规划手术方案及设计出个性化的内置物,使手术效果个体化、精准化,从而缩短手术时间、减少术中出血量,同时对术后骨折的愈合及关节功能恢复均具有较好的预后效果,值得临床进一步推广应用。
Objective:To explore the clinical effect and value of 3D printing assisted operation in the treatment of proximal articular fractures of the extremities.Method:A total of 62 patients with proximal articular fractures of the extremities were treated in our hospital from June 2015 to March 2016 were selected.According to the different surgical methods,they were divided into 32 cases of control group(routine operation) and 30 cases of study group(3D printing technique assisted operation).The operative time,intraoperative bleeding,postoperative fracture healing time,and bad condition after healing were compared between two groups,the joint functional recovery scores were compared at 6,12 and 18 months after operation.Result:The average operative time was(58.6±16.3)min,average intraoperative bleeding was(101.68±23.59)mL,average fracture healing time was(9.6±2.1)months in study group,and control group were(72.3±12.6)min,(135.33±18.67)mL,(13.7±2.6)months respectively,the differences were statistically significant(t=-3.716,-6.248,-6.803;P=0.000,0.000,0.000).They were all healed in stage Ⅰ,and no complications after the operation,the study group had no pain after healing,2 cases of mild intermittent pain in control group after healing,and disappeared after nursing care 3 months,the bad condition after healing of two groups were compared,the difference was not statistically significant(P>0.05).The scores of joint function in study group were all higher than those of control group at 6,12 and 18 months after the operation,the differences were statistically significant(P<0.05).Conclusion:3D printing assisted operation treatment of proximal articular fractures of the extremities,can help the surgeons to make definite preoperative diagnosis,operation planning scheme and design personalized surgical implants,the effects of individual and accurate,so as to shorten the operative time,less bleeding,and has a good effect on the prognosis of fracture healing and joint functional recovery after surgery,it is worthy of further application.
Objective:To explore the clinical effect and value of 3D printing assisted operation in the treatment of proximal articular fractures of the extremities.Method:A total of 62 patients with proximal articular fractures of the extremities were treated in our hospital from June 2015 to March 2016 were selected.According to the different surgical methods,they were divided into 32 cases of control group(routine operation) and 30 cases of study group(3D printing technique assisted operation).The operative time,intraoperative bleeding,postoperative fracture healing time,and bad condition after healing were compared between two groups,the joint functional recovery scores were compared at 6,12 and 18 months after operation.Result:The average operative time was(58.6±16.3)min,average intraoperative bleeding was(101.68±23.59)mL,average fracture healing time was(9.6±2.1)months in study group,and control group were(72.3±12.6)min,(135.33±18.67)mL,(13.7±2.6)months respectively,the differences were statistically significant(t=-3.716,-6.248,-6.803;P=0.000,0.000,0.000).They were all healed in stage Ⅰ,and no complications after the operation,the study group had no pain after healing,2 cases of mild intermittent pain in control group after healing,and disappeared after nursing care 3 months,the bad condition after healing of two groups were compared,the difference was not statistically significant(P>0.05).The scores of joint function in study group were all higher than those of control group at 6,12 and 18 months after the operation,the differences were statistically significant(P<0.05).Conclusion:3D printing assisted operation treatment of proximal articular fractures of the extremities,can help the surgeons to make definite preoperative diagnosis,operation planning scheme and design personalized surgical implants,the effects of individual and accurate,so as to shorten the operative time,less bleeding,and has a good effect on the prognosis of fracture healing and joint functional recovery after surgery,it is worthy of further application.
引文
[1]邹剑,张长青.锁定钢板治疗膝关节周围骨折或骨不连的并发症分析[J].中华创伤骨科杂志,2011,13(3):217-221.
[2]陈彦,丁洪,翟建明,等.关节镜下微创治疗膝关节内骨折的疗效及并发症分析[J].安徽医药,2014,18(4):711-712.
[3]王红川,楼华,刘凯,等.改良外侧胫骨平台骨折塌陷关节面复位方法的疗效观察[J].中国修复重建外科杂志,2013,27(1):12-16.
[4]方钦正,史晨辉,董金波,等.关节镜辅助复位与切开复位治疗胫骨平台骨折的疗效分析[J].临床和实验医学杂志,2012,11(18):1446-1447.
[5]王庆大,李波.3D打印技术在医学领域的应用研究进展[J].重庆医学,2016(1):126-128.
[6]潘雯,宫建.3D可视化、3D打印、虚拟现实、增强现实在医学中作用的研究进展[J].实用医学杂志,2017,33(17):2969-2971.
[7]Briggs K K,Steadman J R,Hay C J,et al.Lysholm score and Tegner activity level in individuals with normal knees[J].Am J Sports Med,2009,37(5):898-901.
[8]胡超,张桃根,蔡林.胫骨平台骨折的治疗现状[J].中国骨与关节损伤杂志,2012,27(2):191-192.
[9]徐云钦,李强,申屠刚,等.复杂胫骨平台骨折手术时机与手术方式选择及疗效分析[J].中国骨与关节损伤杂志,2013,28(4):320-323.
[10]崔硬铁,吴春生.胫骨平台骨折的诊疗进展[J].中华骨与关节外科杂志,2012,5(3):268-273.
[11]王涛.锁定钢板微创治疗四肢近关节端骨折的临床有效性分析[J].临床医学研究与实践,2017,2(18):78-79.
[12]聂涛,戴闽,李明军,等.股骨远端C型骨折手术入路的探讨[J].中国矫形外科杂志,2010,18(18):1580-1581.
[13]周云飞,郭贺荣,徐高峰,等.锁定钢板固定治疗下肢近关节骨折26例[J].总装备部医学学报,2011(4):230-232.
[14]史保庆.3D打印技术在修复骨缺损中的应用探讨[J].中国现代医生,2016,54(18):65-68.
[15]杨华刚,韩涛,文虹杰,等.胫骨干骨折外固定更换内固定时机及内置物选择[J].中华创伤杂志,2014,30(7):652-655.
[16]顾恩毅,史海宁,郑忠,等.负压封闭引流技术治疗骨科手术后感染并内置物外露创面2例[J].福建医药杂志,2011,33(6):142-143.
[17]王小平,韦展图,黄俭.虚拟三维重建术前规划技术在Pilon骨折的应用研究[J].中国修复重建外科杂志,2016,30(1):44-49.
[18]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(3):378-382.
[19]Sciberras N,Frame M,Bharadwaj R G,et al.A Novel Technique for Pre-operative Planning of Severe Acetabular Defects During Revision hip Arthroplasty[J].British Editorial Society of Bone and Joint Surgery,2013,(95):63.
[20]钟华,陈劲,李建炜,等.3D打印辅助Sanders CT分型个性化手术治疗跟骨关节内骨折[J].中国骨科临床与基础研究杂志,2017,9(1):29-35.
[21]黄敏强,丁焕文,黄淼俊,等.3D打印个性化外固定器在严重胫腓骨骨折的初步应用[J].中国修复重建外科杂志,2016,30(2):156-160.
[22]吴毅,吴章林,孙永建,等.3D打印技术在髋臼骨折个性化导航模块设计中的应用[J].分子影像学杂志,2016,39(4):379-382.
[23]贺锦阳,张云鹏,任龙韬.肱骨近端四部分骨折的数字化术前模拟手术规划[J].中国现代医生,2011,49(22):24-25.
[24]林艳萍,陈晓军,张诗雷,等.手术模拟及实时导航技术在颌面部陈旧性骨折修复中的应用[J].上海交通大学学报(医学版),2010,30(1):112-115.
[2]陈彦,丁洪,翟建明,等.关节镜下微创治疗膝关节内骨折的疗效及并发症分析[J].安徽医药,2014,18(4):711-712.
[3]王红川,楼华,刘凯,等.改良外侧胫骨平台骨折塌陷关节面复位方法的疗效观察[J].中国修复重建外科杂志,2013,27(1):12-16.
[4]方钦正,史晨辉,董金波,等.关节镜辅助复位与切开复位治疗胫骨平台骨折的疗效分析[J].临床和实验医学杂志,2012,11(18):1446-1447.
[5]王庆大,李波.3D打印技术在医学领域的应用研究进展[J].重庆医学,2016(1):126-128.
[6]潘雯,宫建.3D可视化、3D打印、虚拟现实、增强现实在医学中作用的研究进展[J].实用医学杂志,2017,33(17):2969-2971.
[7]Briggs K K,Steadman J R,Hay C J,et al.Lysholm score and Tegner activity level in individuals with normal knees[J].Am J Sports Med,2009,37(5):898-901.
[8]胡超,张桃根,蔡林.胫骨平台骨折的治疗现状[J].中国骨与关节损伤杂志,2012,27(2):191-192.
[9]徐云钦,李强,申屠刚,等.复杂胫骨平台骨折手术时机与手术方式选择及疗效分析[J].中国骨与关节损伤杂志,2013,28(4):320-323.
[10]崔硬铁,吴春生.胫骨平台骨折的诊疗进展[J].中华骨与关节外科杂志,2012,5(3):268-273.
[11]王涛.锁定钢板微创治疗四肢近关节端骨折的临床有效性分析[J].临床医学研究与实践,2017,2(18):78-79.
[12]聂涛,戴闽,李明军,等.股骨远端C型骨折手术入路的探讨[J].中国矫形外科杂志,2010,18(18):1580-1581.
[13]周云飞,郭贺荣,徐高峰,等.锁定钢板固定治疗下肢近关节骨折26例[J].总装备部医学学报,2011(4):230-232.
[14]史保庆.3D打印技术在修复骨缺损中的应用探讨[J].中国现代医生,2016,54(18):65-68.
[15]杨华刚,韩涛,文虹杰,等.胫骨干骨折外固定更换内固定时机及内置物选择[J].中华创伤杂志,2014,30(7):652-655.
[16]顾恩毅,史海宁,郑忠,等.负压封闭引流技术治疗骨科手术后感染并内置物外露创面2例[J].福建医药杂志,2011,33(6):142-143.
[17]王小平,韦展图,黄俭.虚拟三维重建术前规划技术在Pilon骨折的应用研究[J].中国修复重建外科杂志,2016,30(1):44-49.
[18]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(3):378-382.
[19]Sciberras N,Frame M,Bharadwaj R G,et al.A Novel Technique for Pre-operative Planning of Severe Acetabular Defects During Revision hip Arthroplasty[J].British Editorial Society of Bone and Joint Surgery,2013,(95):63.
[20]钟华,陈劲,李建炜,等.3D打印辅助Sanders CT分型个性化手术治疗跟骨关节内骨折[J].中国骨科临床与基础研究杂志,2017,9(1):29-35.
[21]黄敏强,丁焕文,黄淼俊,等.3D打印个性化外固定器在严重胫腓骨骨折的初步应用[J].中国修复重建外科杂志,2016,30(2):156-160.
[22]吴毅,吴章林,孙永建,等.3D打印技术在髋臼骨折个性化导航模块设计中的应用[J].分子影像学杂志,2016,39(4):379-382.
[23]贺锦阳,张云鹏,任龙韬.肱骨近端四部分骨折的数字化术前模拟手术规划[J].中国现代医生,2011,49(22):24-25.
[24]林艳萍,陈晓军,张诗雷,等.手术模拟及实时导航技术在颌面部陈旧性骨折修复中的应用[J].上海交通大学学报(医学版),2010,30(1):112-115.