3D打印结合胫骨外髁截骨治疗胫骨平台外后髁骨折  

3D printing technique combined with tibial lateral condyle osteotomy for complex tibial plateau fractures involving the posterolateral condyle

作　　者：焦竞 肖飞 黄玉成 王昕 熊元 李鲲 王俊文[1] 勘武生[1] Jiao ring;Xiao Fei;Huang Yucheng;Wang Xin;Xiong Yuan;Li Kun;Wang Junwen;Kan Wusheng(Department of Orthopaedic Trauma,Wuhan Fourth Hospital,Wuhan Puai Hospital,Tongfi Medical College,Huazhong University of Science and Technology,Wuhan 430033,Chin)

机构地区：[1]武汉市第四医院,华中科技大学同济医学院附属普爱医院骨科,430033

出　　处：《中华骨科杂志》2018年第15期913-918,共6页Chinese Journal of Orthopaedics

基　　金：武汉市卫计委科研项目（2016-WX16D27）

摘　　要：目的 探讨3D打印结合胫骨外髁截骨治疗胫骨平台外后髁骨折的临床疗效.方法 回顾性分析2012年1月至2015年2月,采用3D打印技术结合胫骨外髁截骨治疗并获随访的47例胫骨平台外后髁骨折患者资料,男19例,女28例;年龄21～69岁,平均50.3岁;骨折类型按Schatzker分型：Ⅳ型17例,Ⅴ型18例,Ⅵ型12例;均为闭合性骨折,其中4例合并外侧半月板损伤,但均未合并神经及血管损伤;受伤至手术时间为4～19 d,平均6.7 d.47例患者术前均行CT三维重建,并根据转换后的数据行3D打印,制作出1∶1实体大小的骨折模型,参照3D骨折模型精准设计截骨线完善手术方案.术中采用前外侧联合后内侧切口,按术前3D模型设计的截骨线（胫骨外髁截骨）精准暴露胫骨平台外后髁骨折块,复位后双侧钢板内固定.术后按膝关节Rasmussen评分标准评价骨折复位情况,采用美国特种外科医院（hospital for special surgery,HSS）评分评价膝关节功能.结果 47例患者均获得随访,随访时间7～19个月,平均13.2个月.术后即刻X线片均显示骨折复位良好.骨折愈合时间12～18周,平均14.3周.术后1年膝关节Rasmussen评分为13～18分,平均15.73分,其中优33例,良12例,可2例,优良率95.7％（45/47）.HSS评分为67～94分,平均82.67分,其中优31例,良13例,可2例,差1例（术后因拒绝康复锻炼而发生关节僵硬）,优良率89.9％ （44/47）.膝关节活动度-5°～0°～135°,平均活动范围125.5°.末次随访时,无一例发生腓总神经损伤、腘血管损伤、术后感染、内固定失效等严重并发症.结论 3D打印结合胫骨外髁截骨是治疗胫骨平台外后髁骨折的有效方法,术后治疗结果满意.Objective To investigate the clinical efficacy of 3D printing technique combined with osteotomy in the treatment of complex tibial plateau fractures involving the posterolateral condyle.Methods The clinical data of 47 patients with complicated tibial plateau fractures involving the posterolateral condyle who were treated with 3D printing technology and tibial lateral condyle osteotomy from January 2012 to February 2015 were retrospectively analyzed.There were 19 males and 28 females aged from 21 to 69 years （mean 50.3 years）.All of them were closed fractures without neurological and vascular injuries.The time between injury and operation was 4 to 19 days （average,6.7 days）.All the patients were treated with tibial lateral condyle osteotomy and bilateral plate fixation with anterolateral approach and posteromedial approach.Three-dimensional CT scans were performed preoperatively and 1 ∶ 1 to mimics model was made by 3D printing technique based on the data after conversion.Refer to the 3D fracture model to accurately design the osteotomy line to improve the operation scheme.During the operation,anterior and lateral anterior combined with posterior medial incision were performed,and the tibia external condyle osteotomy was conducted to accurately expose the external posterior condyle fracture block of the tibia platform,and bilateral plate was applied after reduction.The fracture reduction was evaluated according to the Rasmussen score of the knee joint.The knee joint function was evaluated by the score of the hospital for special surgery （HSS）.Results All 47 patients were followed up for 13.2 months （range,7-19 months）.Immediate postoperative X-ray showed good fracture reduction.The union time of fracture was 14.3 weeks （range,12-18 weeks）.The knee joint Rasmussen score one year after operation was 13-18 （average,15.73）,including 33 cases excellent,12 cases good and 2 cases fair.The excellent and good rate was 95.7% （45/47）.HSS score was 67 to 94 （average,82.67）,among which 31 case

关 键 词：胫骨骨折 截骨术 骨折固定术 内 

分 类 号：R687.3[医药卫生—骨科学]