传统手术与应用3D打印技术后手术治疗复杂胫骨平台骨折的疗效比较  

Conventional operation versus 3D printing technology in the treatment of complicated tibial plateau fractures

作　　者：何志勇[1] 张擎柱[1] 林影影 刘正蓬[1] 谷锐[1] 杨小华[1] 

机构地区：[1]承德医学院附属医院创伤骨科,河北承德067000

出　　处：《中国矫形外科杂志》2016年第8期682-686,共5页Orthopedic Journal of China

摘　　要：[目的]比较传统手术与应用3D打印技术后手术治疗复杂胫骨平台骨折的临床疗效。[方法]回顾性分析本院2009年3月~2014年7月收治的73例复杂的胫骨平台骨折的患者资料,男51例,女22例,年龄19~57岁,平均38.2岁,骨折按照Schazker分型：Ⅳ型33例、Ⅴ型24例、Ⅵ型16例;按照CT分型：双柱骨折51例,三柱骨折22例。其中19例术前采用三维CT重建,3D技术打印实体模型,并在3D模型上模拟手术,术中按术前计划手术（3D技术组）。54例行常规CT扫描、术前准备及手术（常规组）。记录两组患者手术时间、术中出血量、骨折复位质量、手术并发症发生率,术后12个月按照HSS标准进行膝关节功能评分。[结果]所有患者均进行12个月~4年随访（平均24个月）。与常规组相比较,3D技术组手术时间缩短,术中出血量减少,术后12个月膝关节功能HSS评分高,两组间差异有统计学意义（P〈0.05）;术后第2 d拍膝关节X线片,3D组：解剖复位17例,移位〈1 mm 1例,移位〉1 mm 1例,解剖复位率89.4%;常规组：解剖复位35例,移位〈1 mm 15例,移位〉1 mm4例,解剖复位率64.8%,两组间比较差异有统计学意义（P〈0.05）;3D技术组与常规组分别出现创伤性关节炎1例、3例;关节僵直0例、2例;关节不稳1例、3例;下肢深静脉血栓形成0例、1例,两组间比较差异无统计学意义（P〉0.05）。[结论]3D打印技术治疗复杂胫骨平台骨折,可降低手术时间,减少手术出血量,提高骨折复位质量,有效恢复膝关节功能,具有明显的优势。[Objective]To compare the clinical outcomes between traditional operation and application of 3D printing technology in the treatment of complicated tibial plateau fractures. [Method]A retrospective analysis was performed on 73 cases of complicated tibial plateau fractures at our department from March 2009 to July 2014. There were 53 male and 22 female patients. Their age ranged from 19 to 57 years（ average,38. 2 years）. According to the Schazker classification,33 cases were typeⅣ,24 cases were typeⅤ,16 cases were Ⅵ. According to the CT classification,51 cases were double columns fracture,22 cases were three columns fracture. Of them,19 underwent CT 3D reconstruction,3D printing and rapid prototyping before surgery（ 3D group）,and 54 underwent conventional CT scanning before surgery（ control group）. The intraoperative bleeding,operation time,fracture union,operation-related complications were compared between the two groups. The knee joint function was also compared according to the HSS criteria 12 months after operation. [Result]All the patients were followed up for 12 months to 4 years（ mean,24 months）. The 3D group had less significantly operation time,intraoperative bleeding,and higher HSS scores than control group 12 months after operation（ P 〈 0. 05）. All the patients underwent knee joint X-ray at the second day after operation. In the 3D group,anatomical reduction were achieved in 17 cases,shift 〈 1 mm was found in 1 case,shift 〉 1 mm in 1 case,the anatomical reattachment rate was 89. 4%. In the control group,anatomical reduction were achieved in 35 cases,shift〈 1 mm were found in 15 cases,shift 〉 1 mm in 4 cases,the anatomical reattachment rate was 64. 8%,showing a significant difference compared to that of 3D group（ P 〈 0. 05）. In 3D group and the control group,traumatic arthritis was found in 1 and 3 cases,joint stiffness in 0 and 2 cases,joint instability in 1 and 3 cases and,deep venous thrombosis in 0 and 1 cases respectively,without significant difference betw

关 键 词：胫骨平台 3D打印技术 模拟手术 

分 类 号：R687.3[医药卫生—骨科学]