3D打印技术在复杂跟骨骨折手术治疗中的初步应用研究
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摘要
目的探讨3D打印技术在复杂跟骨骨折手术术前谈话以及手术操作中的临床应用价值。方法收集2016年1月—2017年12月延安大学附属医院收治的成人单侧复杂跟骨骨折患者39例,根据不同辅助完成术前谈话以及手术操作的方法分为两组。3D组19例患者术前采用3D打印技术制作等比例骨折实体模型,辅助完成术前谈话及手术操作;常规组患者20例采用常规影像学资料辅助完成术前谈话及手术操作。仿照视觉模拟评分法评估两组术前谈话时患者及家属对病情和手术的理解程度、沟通满意度;并比较两组患者术前谈话时间、手术时间、术中出血量、术后Maryland评分优良率及并发症发生率。结果 3D组患者术前谈话时间短于常规组,沟通满意度评分高于常规组,差异均有统计学意义(P<0.01);两组患者病情及手术理解程度评分比较差异无统计学意义(P> 0.05)。3D组患者手术时间短于常规组,术中出血量少于常规组,差异均有统计学意义(P<0.01)。两组患者术后Maryland评分优良率及并发症发生率比较差异均无统计学意义(P> 0.05)。结论在复杂跟骨手术治疗过程中,3D打印技术有助于术前谈话顺畅进行,提升医患沟通效率,并且可指导术者制定有效的手术治疗方案,显著缩短手术时间、减少术中出血量,获得最佳的手术治疗效果。
Objective To research the clinical application value of 3D printing technology in preoperative conversations and surgical procedures of complicated calcaneal fractures.Methods Thirty-nine patients with unilateral complicated calcaneal fractures treated in our hospital from January 2016 to December 2017 were enrolled as research subjects and divided into two groups by the different methods of assisting preoperative conversations and surgical procedures.Nineteen cases in the 3D group were preoperatively selected to make a proportional fracture solid model using 3D printing technology,to assist in the preoperative conversation and surgical procedures.For the other 20 cases in the conventional group,routine imaging was used to assist in preoperative conversation and surgical procedures.The imitated visual analogue scale(VAS) was used to evaluate the understanding and communication satisfaction of patients and their families in preoperative conversation.The length of conversation,the duration of operation,the intraoperative blood loss,the excellent rate of Maryland's score,and the incidence of complications were compared between the two groups.Results The length of conversation and the communication satisfaction score in the 3D group were significantly shorter or higher than those in the conventional group(P<0.01).There were no significant differences in the understanding degree of the disease and operation between the two groups(P>0.05).The duration of operation and the intraoperative blood loss in the 3D group were significantly shorter or less than those in the conventional group(P<0.01).There were no significant differences in the excellent rate of Maryland's score,and the incidence of complications between the two groups(P>0.05).Conclusion In the process of complicated calcaneal surgery,3D printing technology helps smooth preoperative conversations,improve doctor-patient communication efficiency,and guide surgeons in the development of effective surgical treatment programs,which can significantly shorten the duration of operation,and reduce intraoperative blood loss,thereby achieving the optimal clinical efficacy.
Objective To research the clinical application value of 3D printing technology in preoperative conversations and surgical procedures of complicated calcaneal fractures.Methods Thirty-nine patients with unilateral complicated calcaneal fractures treated in our hospital from January 2016 to December 2017 were enrolled as research subjects and divided into two groups by the different methods of assisting preoperative conversations and surgical procedures.Nineteen cases in the 3D group were preoperatively selected to make a proportional fracture solid model using 3D printing technology,to assist in the preoperative conversation and surgical procedures.For the other 20 cases in the conventional group,routine imaging was used to assist in preoperative conversation and surgical procedures.The imitated visual analogue scale(VAS) was used to evaluate the understanding and communication satisfaction of patients and their families in preoperative conversation.The length of conversation,the duration of operation,the intraoperative blood loss,the excellent rate of Maryland's score,and the incidence of complications were compared between the two groups.Results The length of conversation and the communication satisfaction score in the 3D group were significantly shorter or higher than those in the conventional group(P<0.01).There were no significant differences in the understanding degree of the disease and operation between the two groups(P>0.05).The duration of operation and the intraoperative blood loss in the 3D group were significantly shorter or less than those in the conventional group(P<0.01).There were no significant differences in the excellent rate of Maryland's score,and the incidence of complications between the two groups(P>0.05).Conclusion In the process of complicated calcaneal surgery,3D printing technology helps smooth preoperative conversations,improve doctor-patient communication efficiency,and guide surgeons in the development of effective surgical treatment programs,which can significantly shorten the duration of operation,and reduce intraoperative blood loss,thereby achieving the optimal clinical efficacy.
引文
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[18]吴敏,官建中,肖玉周,等.3-D打印技术辅助经皮撬拨空心钉内固定治疗移位的跟骨关节内骨折[J].中国修复重建外科杂志,2017,31(11):1316-1321.
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[21]陈克,潘振宇.3D打印技术在SandersⅡ、Ⅲ型跟骨骨折手术治疗中的临床应用[J].创伤外科杂志,2017,19(7):508-512.
[22]Niikura T,Sugimoto M,Lee S Y,et al.Tactile surgical navigation system for complex acetabular fracture surgery[J].Orthopedics,2014,37(4):237-242.
[23]贺刚,陈峰,陈治清.数字化医患沟通在复杂种植病例中的应用[J].中国口腔种植学杂志,2012,17(3):120-123.
[24]王燎,戴尅戎.骨科个体化治疗与3D打印技术[J].医用生物力学,2014,29(3):193-199.
[25]云致硕,黄家生.跟骨骨折3D模型制作的探讨[J].医疗装备,2015,28(6):30-32.
[26]Gelalis I D,Paschos N K,Pakos E E,et al.Accuracy of pedicle screw placement:a systematic review of prospective in vivo studies comparing free hand,fluoroscopy guidance and navigation techniques[J].Eur Spine J,2012,21(2):247-255.
[27]王宇辰,陈云丰.3D打印技术在临床骨科中的应用[J].国际骨科学杂志,2016,37(6):358-362.
[28]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.
[29]姜雨晨,陈雁西.3D打印技术在足踝外科的应用价值[J].国际骨科学杂志,2015,36(1):15-17.
[30]马向浩,张蕾蕾,张颖,等.3D打印技术骨科临床应用进展[J].中国数字医学,2016,11(6):2-5.
[2]Wang Q,Chen W,Su Y,et al.Minimally invasive treatment of calcaneal fracture by percutaneous leverage,anatomical plate,and compression bolts--the clinical evaluation of cohort of 156 patients[J].JTrauma,2010,69(6):1515-1522.
[3]李新春,康麟,庞渊.3D打印技术在Pilon骨折手术治疗中的应用[J].新疆医科大学学报,2015,38(4):471-473.
[4]赵移畛,杜天信,杨超凡,等.3D骨科医患沟通系统临床应用效果评估[J].中医药管理杂志,2015,23(17):95-96.
[5]Mironov V,Trusk T,Kasyanov V,et al.Biofabrication:a 21st century manufacturing paradigm[J].Biofabrication,2009,1(2):022001.
[6]Hwang T J,Kiang C,Paul M.Surgical applications of 3-dimensional printing and precision medicine[J].JAMA Otolaryngol Head Neck Surg,2015,141(4):305-306.
[7]Zhang X,Liu Y,Peng A,et al.Clinical efficacy and prognosis factors of open calcaneal fracture:a retrospective study[J].Int J Clin Exp Med,2015,8(3):3841-3847.
[8]严广斌.视觉模拟评分法[J].中华关节外科杂志(电子版),2014,8(2):273.
[9]赵晶晶,黄若昆,雷波,等.三维C臂辅助下闭合复位螺钉固定治疗SandersⅡ型跟骨骨折[J].中国现代医学杂志,2015,25(14):89-92.
[10]王波群,许永先,李友余,等.3D打印技术在跟骨粉碎性骨折个性化诊疗中的临床应用[J].中国数字医学,2017,12(8):76-78,87.
[11]Bevill G,Keaveny T M.Trabecular bone strength predictions using finite element analysis of microscale images at limited spatial resolution[J].Bone,2009,44(4):579-584.
[12]Jiang N,Lin Q R,Diao X C,et al.Surgical versus nonsurgical treatment of displaced intra-articular calcaneal fracture:a meta-analysis of current evidence base[J].Int Orthop,2012,36(8):1615-1622.
[13]黄家生,云致硕.3D打印技术在跟骨骨折手术治疗中的应用[J].中国医药科学,2016,6(10):198-200.
[14]卢华定,李全喜,赵慧清,等.三维CT重建影像在跟骨骨折诊疗中的临床应用[J].中国实用医药,2013,8(27):25-26.
[15]陈雁西,俞光荣.踝关节骨折的治疗策略与数字化临床路径[J].中华骨科杂志,2011,31(3):275-284.
[16]Hao S,Wang F,Liu Z,et al.3D printing mirror model to assist MIPPO technology in the treatment of displaced midshaft clavicle fracture:a case report[J].Int J Clin Exp Med,2018,11(3):2717-2720.
[17]刘凯,王红川,蒋俊威,等.3D打印辅助小切口复位内固定治疗跟骨骨折[J].华西医学,2016,31(5):859-862.
[18]吴敏,官建中,肖玉周,等.3-D打印技术辅助经皮撬拨空心钉内固定治疗移位的跟骨关节内骨折[J].中国修复重建外科杂志,2017,31(11):1316-1321.
[19]孔令军.100例患者家属术前谈话的心理反应调查分析[J].中国医院管理,2002(8):54-55.
[20]石高寒,郭再萍.沟通,架起医患和谐的桥梁[J].医院管理论坛,2011,28(6):15-16.
[21]陈克,潘振宇.3D打印技术在SandersⅡ、Ⅲ型跟骨骨折手术治疗中的临床应用[J].创伤外科杂志,2017,19(7):508-512.
[22]Niikura T,Sugimoto M,Lee S Y,et al.Tactile surgical navigation system for complex acetabular fracture surgery[J].Orthopedics,2014,37(4):237-242.
[23]贺刚,陈峰,陈治清.数字化医患沟通在复杂种植病例中的应用[J].中国口腔种植学杂志,2012,17(3):120-123.
[24]王燎,戴尅戎.骨科个体化治疗与3D打印技术[J].医用生物力学,2014,29(3):193-199.
[25]云致硕,黄家生.跟骨骨折3D模型制作的探讨[J].医疗装备,2015,28(6):30-32.
[26]Gelalis I D,Paschos N K,Pakos E E,et al.Accuracy of pedicle screw placement:a systematic review of prospective in vivo studies comparing free hand,fluoroscopy guidance and navigation techniques[J].Eur Spine J,2012,21(2):247-255.
[27]王宇辰,陈云丰.3D打印技术在临床骨科中的应用[J].国际骨科学杂志,2016,37(6):358-362.
[28]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.
[29]姜雨晨,陈雁西.3D打印技术在足踝外科的应用价值[J].国际骨科学杂志,2015,36(1):15-17.
[30]马向浩,张蕾蕾,张颖,等.3D打印技术骨科临床应用进展[J].中国数字医学,2016,11(6):2-5.