3D打印技术在桡骨远端不稳定性骨折微创治疗中的应用
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摘要
目的:探讨3D打印技术辅助下微创手术在桡骨远端不稳定性骨折治疗中的临床应用。方法:选取桡骨远端不稳定性骨折病人25例,分为3D打印技术辅助下微创(闭合或有限切开)复位克氏针内固定外固定支架外固定组(MIS组)12例和切开复位锁定板内固定组(ORIF组)13例。比较2组病人手术时间和切口长度,术后随访病人腕关节掌屈、背伸、尺偏、桡偏、旋前、旋后六个方向的活动度,复查腕关节正侧位片,观察对掌倾角、尺偏角、桡骨长度及关节面恢复情况,应用Gartland-Werley腕关节功能评分表对2组病人腕关节功能进行评分并比较。结果:2组病人均顺利完成手术,MIS组手术时间明显短于ORIF组(P<0.01),手术切口长度明显小于ORIF组(P<0.01)。2组病人术后腕关节均复位良好,腕关节活动度和功能评分优良率差异均无统计学意义(P>0.05)。结论:应用3D打印技术辅助下微创(闭合或有限切开)复位克氏针内固定外固定支架外固定治疗桡骨远端不稳定性骨折,切口小,手术时间短,腕关节功能恢复良好,且可避免二次手术。
Objective:To investigate the clinical application value of 3 D printing technology in the mini-invasive treatment of unstable distal radius fractures.Methods:Twenty-five patients with unstable distal radius fracture were divided into the MIS group(12 cases) and ORIF group(13 cases).The MIS group and ORIF group were treated with mini-invasive surgery reduction(close reduction or limited incision reduction) combined with external fixation assisted by 3 D printing technology,and open reduction combined with internal fixation,respectively.The operation time,incision size and postoperative following-up of the activity of wrist motion(palmarflexion,dorsiflexion,ulnardeviation,radialdeviation,pronation,supinaion) were compared between two groups.The recovery of palmar inclination,ulnar deviation,radial length and joint surface in two groups were observed using the positive and lateral wrist radiographs.According to Gartland-Werley scoring criteria,the wrist joint function between two groups was evaluated and compared.Results:The operation in two groups was successfully completed,and the average operation time and incision length in MIS group were less than those in ORIF group(P<0.01).The recovery of wrist joint function in two groups was good,and the differences of the excellent and good rate of the activity of the wrist motion,and score of wrist joint function between two groups were not statistically significant(P>0.05).Conclusions:The mini-invasive surgery reduction(close reduction or limited incision reduction) combined and external fixation assisted by 3 D printing technology combined with open reduction and internal fixation in the treatment of the unstable distal radius fractures has little incision,short operation time and good recovery of wrist joint function,which can avoid secondary surgery.
Objective:To investigate the clinical application value of 3 D printing technology in the mini-invasive treatment of unstable distal radius fractures.Methods:Twenty-five patients with unstable distal radius fracture were divided into the MIS group(12 cases) and ORIF group(13 cases).The MIS group and ORIF group were treated with mini-invasive surgery reduction(close reduction or limited incision reduction) combined with external fixation assisted by 3 D printing technology,and open reduction combined with internal fixation,respectively.The operation time,incision size and postoperative following-up of the activity of wrist motion(palmarflexion,dorsiflexion,ulnardeviation,radialdeviation,pronation,supinaion) were compared between two groups.The recovery of palmar inclination,ulnar deviation,radial length and joint surface in two groups were observed using the positive and lateral wrist radiographs.According to Gartland-Werley scoring criteria,the wrist joint function between two groups was evaluated and compared.Results:The operation in two groups was successfully completed,and the average operation time and incision length in MIS group were less than those in ORIF group(P<0.01).The recovery of wrist joint function in two groups was good,and the differences of the excellent and good rate of the activity of the wrist motion,and score of wrist joint function between two groups were not statistically significant(P>0.05).Conclusions:The mini-invasive surgery reduction(close reduction or limited incision reduction) combined and external fixation assisted by 3 D printing technology combined with open reduction and internal fixation in the treatment of the unstable distal radius fractures has little incision,short operation time and good recovery of wrist joint function,which can avoid secondary surgery.
引文
[1] ALLURI R,LONGACRE M,PANNELL W,et al.Volar,intramedullary,and percutaneous fixation of distal radius fractures[J].J Wrist Surg,2015,4(4):292.
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[8] 赵继荣,李红专,慕向前.桡骨远端骨折的非手术治疗进展[J].中国中医骨伤科杂志,2015,23(12):77.
[9] 巩海贤,刘永涛.桡骨远端骨折治疗进展[J].滨州医学院学报,2013,36(1):52.
[10] LICHTMAN DM,BIUDRA RR,BOYER MI,et al.American Academy of Orthopaedic Surgeons Clinical practice guideline on:the treatment of distal radius fractures[J].J Bone Joint Surg Am,2011,93(8):775.
[11] NESBITT KS,FAIDIA JM,LES C.Assessment 0f instability factors in adult distal radial fractures[J].J Hand Surg Am,2004,29(6):1128.
[12] COSTA ML,ACHTEN J,PLANT C,et al.UK DRAFFT:a randomised controlled trial of percutaneous fixation with Kirschner wires versus volar locking-plate fixation in the treatment of adult patients with a dorsally displaced fracture of the distal radius[J].Health Technol Assess,2015,19(17):1.
[13] 李德胜,李皓恒.掌侧锁定钢板内固定与外固定支架修复桡骨远端不稳定性骨折:随机对照[J].中国组织工程研究,2015,19(9):1429.
[14] 张计成,张辉,刘向阳.外固定架联合交叉克氏针固定治疗桡骨远端不稳定性骨折[J].实用骨科杂志,2012,18(5):473.
[15] BAJWA AS,RAMMAPPA M,LEE L,et al.Treatment of unstable distal radius fractures:non-invasive dynamic external xator versus volar locking plate-functional and radiological outcome in a prospective case-controlled series[J].SICOT J,2015,1(34):1.
[16] STAROSOLSKI ZA,KAN JH,ROSENFELD SD,et al.Application of 3-D printing (rapid prototyping) for creating physical models of pediatric orthopedic disorders[J].Pediatr Radiol,2014,44(2):216.
[2] MINEGISHI H,DOHI O,AN S,et al.Treatment of unstable distal radius fractures with the volar locking plate[J].Ups J Med Sci,2011,116(4):280.
[3] CHIRPAZ-CERBAT JM,RUATTI S,HOUILLON C,et al.Dorsally displaced distal radius fractures treated by fixed-angle volar plating:Grip and pronosupination strength recovery.A prospective study[J].Orthop Traumatol Surg Res,2011,97(5):465.
[4] ZENKE Y,SAKAI A,OSHIGE T,et al.Clinical results of volar locking plate for distal radius fractures:conventional versus minimally invasive plate osteosynthesis[J].J Orthop Trauma,2011,25(7):425.
[5] RICHARD MJ,WARTINBEE DA,RIBOH J,et al.Analysis of the complications of palmar plating versus external fixation for fractures of the distal radius[J].J Hand Surg Am,2011,36(10):1614.
[6] BERGLUND LM,MESSER TM.Complications of volar plate fixation for managing distal radius fractures[J].J Am Acad Orthop Surg,2009,17(6):369.
[7] MARGALIOT Z,HASSE SC,KOTSIS SV,et al.A meta-analysis of outcomes of external fixation versus plate osteosynthesis for unstable distal radius fractures[J].J Hand Surg,2005,30(6):1185.
[8] 赵继荣,李红专,慕向前.桡骨远端骨折的非手术治疗进展[J].中国中医骨伤科杂志,2015,23(12):77.
[9] 巩海贤,刘永涛.桡骨远端骨折治疗进展[J].滨州医学院学报,2013,36(1):52.
[10] LICHTMAN DM,BIUDRA RR,BOYER MI,et al.American Academy of Orthopaedic Surgeons Clinical practice guideline on:the treatment of distal radius fractures[J].J Bone Joint Surg Am,2011,93(8):775.
[11] NESBITT KS,FAIDIA JM,LES C.Assessment 0f instability factors in adult distal radial fractures[J].J Hand Surg Am,2004,29(6):1128.
[12] COSTA ML,ACHTEN J,PLANT C,et al.UK DRAFFT:a randomised controlled trial of percutaneous fixation with Kirschner wires versus volar locking-plate fixation in the treatment of adult patients with a dorsally displaced fracture of the distal radius[J].Health Technol Assess,2015,19(17):1.
[13] 李德胜,李皓恒.掌侧锁定钢板内固定与外固定支架修复桡骨远端不稳定性骨折:随机对照[J].中国组织工程研究,2015,19(9):1429.
[14] 张计成,张辉,刘向阳.外固定架联合交叉克氏针固定治疗桡骨远端不稳定性骨折[J].实用骨科杂志,2012,18(5):473.
[15] BAJWA AS,RAMMAPPA M,LEE L,et al.Treatment of unstable distal radius fractures:non-invasive dynamic external xator versus volar locking plate-functional and radiological outcome in a prospective case-controlled series[J].SICOT J,2015,1(34):1.
[16] STAROSOLSKI ZA,KAN JH,ROSENFELD SD,et al.Application of 3-D printing (rapid prototyping) for creating physical models of pediatric orthopedic disorders[J].Pediatr Radiol,2014,44(2):216.