3D打印技术在复杂髋臼骨折治疗中的应用  

3D printing used in treatment of complex acetabular fractures

作　　者：张国明[1] 周东生[1] 贺宇[1] 王伯珉[1] 李连欣[1] 李庆虎[1] 余也 

机构地区：[1]山东大学附属省立医院创伤骨科,济南250021

出　　处：《中华创伤骨科杂志》2016年第4期306-311,共6页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨3D打印技术在复杂髋臼骨折治疗中的应用价值。方法回顾性分析2009年1月至2013年12月行手术治疗并获完整随访的121例复杂髋臼骨折患者资料。53例患者采用3D打印技术进行手术计划（3D组）：男36例，女17例；平均年龄（41．2±10．4）岁。68例未应用3D打印技术（常规组）：男42例，女26例；平均年龄（42．6±8．9）岁。3D组与常规组髋臼骨折采用Judet—Letournel分型：T形骨折7、9例，后柱伴后壁骨折4、6例，横形伴后壁骨折21、28例，前方伴后半横行骨折5、6例，双柱骨折16、19例。记录两组患者的手术时间、术中出血量、围手术期输血量、术中透视次数、并发症情况等指标。末次随访时采用MerleD’Aubign6＆Postel评分评定髋臼骨折临床结果，并使用Matta评分评定髋臼骨折影像学结果。两组患者术前一般资料比较差异均无统计学意义（P〉0．05），具有可比性。结果3D组和常规组手术时间平均分别为（3．5±0．9）、（4．5±1．1）h，术中出血量平均分别为（1200．2±232．8）、（1550．4±211．6）mL，围手术期输血量平均为（8．9±3．8）、12．3±2．9）u，术中透视次数平均为（8．7±2．1）、（11．9±2．4）次，以上项目两组间比较差异均有统计学意义（P〈0．05）。3D组与常规组患者术后分别获平均20．3、37．8个月随访，髋臼骨折均获愈合，手术至完全负重行走间隔平均均为3．5个月。3D组与常规组分别有5、7例患者发生医源性坐骨神经损伤，分别有3、5例患者发生术后浅表感染。两组患者均无一例患者发生过性医源性血管损伤、骨不愈合、内固定失效等并发症。末次随访时3D组与常规组采用Merle D’Aubign6＆Postel评分评定髋臼骨折临床结果：优良率分别为64．2％（34／53）、64．7％（44／68）；采用Matta评分评定髋臼骨折影像学结果：优良率分别为73．6％（3Objective To evaluate 3D printing used in the treatment of complex aeetabular fractures. Methods Between January 2009 and December 2013, 121 patients with complex acetabular fi＇acture were treated at our department. 3D printing was used in surgical planning in 53 of them, including 36 males and 17 females with an average age of 41.2 ± 10. 4 years （3D group）. The other 68 patients received conventional surgery without use of 3D printing, including 42 males and 26 females with an average age of 42.6 ± 8.9 years （conventional group）. By the Judet-Letournel classification system, there were respectively 7 and 9 T-type fractures, 4 and 6 posterior column with posterior wall fractures, 21 and 28 transverse and posterior wall fractures, 5 and 6 anterior with the second half transverse fractures, and 16 and 19 double column fractures. Surgical time, blood loss, transfusion, fluoroscopy times and complications were recorded in the 2 groups. At the final follow-ups, the clinical results were assessed by Merle D＇Aubign6 ＆ Postel scoring and the radiographic results were assessed by Matta records. The 2 groups were similar in preoperative demographic data （ P 〉 0. 05） . Results In the 3D and conventional groups, respectively, surgical time was 3.5 ±0.9 hours versus 4. 5 ± 1.1 hours, blood loss was 1,200.2 ±232.8 mL versus 1,550.4 ±211.6 mL, transfusion was 8.9±3.8 U versus 12.3 ±2.9 U, and fluoroscopy times were 8.7±2. 1 versus 11.9 ± 2.4. The differences between the 2 groups were statistically significant （ P 〈 0. 05） . The 3D and convert-tional groups were respectively followed up for 20.3 and 37.8 months on average. All the acetabular fractures healed. The time from surgery to full-weight-bearing walking averaged 3.5 months. Iatrogenic ischiadic nerve injury occurred in 5 and 7 eases and superficial infection in 3 and 5 eases in the 3D and conventional groups, respectively. No iatrogenic vascular injury, nonunion, or implant failure occurred in the 2 groups. By the Merle D＇ Aubign6 �

关 键 词：骨折 髋臼 骨折固定术 内 3D打印技术 

分 类 号：R687.3[医药卫生—骨科学] TP391.73[医药卫生—外科学]