CT扫描三维重建联合3D打印辅助内固定治疗原位股骨髁部骨折的疗效  

Internal fixation of in situ femoral condyle fractures assisted by CT scanning for 3D reconstruction and 3D printing

作　　者：龚立[1] 孔令超[1] 王延鹤[1] 吕飞飞[1] Gong Li;Kong Lingchao;Wang Yanhe;Lyu Feifei(Department of Traumatic Orthopaedics,The First People's Hospital of Hefei,Hefei 230061,China)

机构地区：[1]合肥市第一人民医院创伤骨科,230061

出　　处：《中华创伤骨科杂志》2019年第8期687-692,共6页Chinese Journal of Orthopaedic Trauma

基　　金：国家卫生计生委医药卫生科技发展研究中心项目(W2015QJ062)

摘　　要：目的探讨CT扫描三维重建联合3D打印辅助内固定治疗原位股骨髁部骨折的效果。方法回顾性分析2013年6月至2018年1月合肥市第一人民医院创伤骨科采用内固定治疗的111例原位股骨髁骨折患者资料。男59例,女52例;年龄20~59岁,平均47岁。根据患者是否采用3D打印技术辅助手术分为2组:观察组74例患者在获得三维图像后采用3D打印技术辅助完成手术,男38例,女36例;年龄(44.5±4.7)岁;骨折AO分型:C1型20例,C2型40例,C3型14例。对照组37例患者仅采用CT扫描三维重建辅助下完成手术,男21例,女16例;年龄(43.1±4.6)岁;骨折AO分型:C1型8例,C2型19例,C3型10例。统计并比较两组手术时间、骨折临床愈合时间、术中出血量、住院时间及透视照射次数、美国特种外科医院膝关节评分(HSS)、采用各种固定方式使用率及术后并发症发生率。结果观察组和对照组原位股骨髁部骨折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。所有患者术后获8~12个月,平均10.6个月随访。观察组手术时间(62.3±4.7)min、骨折愈合时间(21.2±3.4)周、住院时间(14.9±3.3)d均短于对照组(89.5±6.0)min、(25.1±3.5)周、(23.5±3.5)d,术中出血量(84.1±11.1)mL、透视照射次数(2.1±0.3)次、HSS评分(94.1±4.2)分均少于对照组(129.6±14.7)mL、(4.7±0.4)次、(86.5±4.6)分,以上指标两组间比较差异均有统计学意义(P<0.05)。观察组与对照组"L"型髁钢板、动力髁螺钉、逆行交锁髓内钉、微创内固定系统使用率比较差异均无统计学意义(P>0.05)。观察组与对照组术后异常愈合、关节粘连、固定物断裂、切口感染并发症发生率比较差异均无统计学意义(P>0.05)。结论CT扫描三维重建用于原位股骨髁骨折患者中能实现骨折块多角度观察,而3D打印技术数据源于CT扫描三维重建并进行实物模型打印,二者结合能帮助患者选择合适的固定方式,利于骨折复位。Objective To investigate the efficacy of CT scanning for 3D reconstruction and 3D printing in the internal fixation for in situ femoral condyle fractures.Methods A retrospective study was conducted of the 111 patients with in situ femoral condyle fracture who had been treated by internal fixation at Department of Traumatic Orthopaedics,The First People's Hospital of Hefei from June 2013 to January 2018.They were 59 males and 52 females,aged from 20 to 59 years(average,47 years).In 74 of them(observation group),the internal fixation was assisted by 3D printing using 3D images.There were 38 males and 36 females with an age of 44.5±4.7 years;there were 20 cases of type C1,40 cases of type C2 and 14 cases of type C3 according to the AO classification.In the other 37 patients(control group),the operation was assisted only by 3 D scanning.There were 21 males and 16 females with an age of 43.1±4.6 year;there were 8 cases of type C1,19 cases of type C2 and 10 cases of type C3 according to the AO classification.The 2 groups were compared in terms of operation time,clinical fracture healing time,intraoperative blood loss,hospital stay,number of fluoroscopy,knee joint score of Hospital for Special Surgery(HSS),fixation modes and postoperative complications.Results There were no significant differences in the preoperative general data between the 2 groups,showing comparability(P>0.05).All the patients were followed up for 8 to 12 months(average,10.6 months).The observation group had significantly shorter operation time(62.3±4.7 minutes),fracture healing time(21.2±3.4 weeks)and hospital stay(14.9±3.3 days)than the control group(89.5±6.0 minutes,25.1±3.5 weeks,23.5±3.5 days)(P<0.05).In the observation group,the intraoperative blood loss(84.1±11.1 mL),fluoroscopy number(2.1±0.3 times)and HSS score(94.1±4.2 points)were significantly less than those in the control group(129.6±14.7 mL,4.7±0.4 times and 86.5±4.6 points)(P<0.05).There were no significant differences between the 2 groups in the use of L type iliac plate

关 键 词：股骨 成像 三维 治疗 计算机辅助 原位股骨髁骨折 3D打印技术 

分 类 号：R68[医药卫生—骨科学]