3D打印技术在移位髋臼骨折合并不稳定型骨盆后环损伤治疗中的应用  

Application of 3D printing technology in treatment of displaced acetabular fractures complicated with posterior pelvic ring injury

作　　者：张伟[1] 王庆雷[1] 张铁良[2] 贾健[2] 

机构地区：[1]北京老年医院骨科,100095 [2]天津医院创伤外科,300211

出　　处：《中华创伤骨科杂志》2017年第8期696-702,共7页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨3D打印技术在移位髋臼骨折合并不稳定型骨盆后环损伤治疗中的应用价值。方法回顾性分析2009年8月至2015年6月期间收治的19例移位髋臼骨折合并不稳定型骨盆后环损伤患者资料。男12例，女7例；年龄为24～62岁，平均39．8岁。移位髋臼骨折合并同侧不稳定型骨盆后环损伤12例、对侧不稳定型骨盆后环损伤5例、双侧不稳定型骨盆后环损伤2例。于术前采集患者CT断层扫描数据进行数字化三维重建，3D打印制造骨盆骨折实体模型，直观评估骨折移位情况并指导手术。结果19例患者在模型的指导下完成手术，手术时间平均为3．2h，术中出血量平均为658．5mL。19例患者术后获8～24个月（平均10．7个月）随访。术后根据Matta标准评定髋臼骨折复位质量：解剖复位14例，满意复位2例，复位不满意3例；根据Mears标准评定骨盆后环损伤复位质量：解剖复位13例，良好复位4例，复位差2例。19例患者髋臼骨折愈合时间为9～18周，平均14．5周；骨盆骨折愈合时间为8～17周，平均13．5周。末次随访时根据改良的Merle d＇Aubign6和Postel评分标准评定髋臼骨折临床结果：优7例，良9例，可1例，差2例；根据Majeed评分标准评定骨盆骨折临床结果：优10例，良7例，可1例，差1例。并发症：切口感染1例，异位骨化2例，股骨头缺血性坏死1例，创伤性关节炎1例。结论对于移位髋臼骨折合并不稳定型骨盆后环损伤，3D打印技术能够精确和直观地反映髋臼及骨盆骨折的情况，指导制定手术计划，疗效良好。Objective To evaluate the application of 3D printing technology in the treatment of displaced acetabular fractures （DAF） complicated with unstable injury to the posterior pelvic ring. Meth- ods A retrospective study was conducted of all the 19 DAF patients complicated with unstable posterior pelvic ring who had been treated from August 2009 to June 2015 in our hospital. They were 12 men and 7 women, aged from 24 to 62 years （average, 39.8 years） . Twelve DAFs were complicated with ipsilateral unstable injury to the posterior pelvic ring, 5 with contralateral unstable injury to the posterior pelvic ring, and 2 with bilateral unstable injury to the posterior pelvic ring. Preoperatively, 3D digital models of the pelvis were reconstructed for the 19 patients using their CT scanning data. Their pelvic models were printed using 3D printing technology for visual evaluation of their fractures and design of individualized surgical proce- dures. Results With the help of their 3D printing models, the 19 patients obtained successful operations within a mean time of 3.2 hours. Their intraoperative blood loss averaged 658.5 mL. They were followed up for an average of 10. 7 months （range, from 8 to 24 months）. According to Matta＇s criteria for pelvic reduc- tion, 14 cases achieved anatomical reduction, 2 satisfactory reduction and 3 unsatisfactory reduction. Ac- cording to Mears＇s criteria for reduction of the posterior pelvic ring, 13 cases achieved anatomical reduction, 4 satisfactory reduction and 2 unsatisfactory reduction. The 19 acetabular fractures healed after 9 to 18 weeks （average, 14.5 weeks）. The pelvic fractures healed after 8 to 17 weeks （average, 13.5 weeks）. According to the Merle d＇Aubigne-Postel criteria at the last follow-ups, the hip functions were excellent in 7, good in 9, fair in one, and poor in 2 cases. According to the Majeed＇s functional evaluation, the pelvic functions were excellent in 10 cases, good in 7, fair in one, and poor in one. Complications were incision infectio

关 键 词：骨盆 髋臼 骨折 3D打印技术 

分 类 号：R687.3[医药卫生—骨科学]