术前3D打印设计结合微创经皮钢板内固定技术治疗胫骨中下段骨折的疗效分析  

Therapeutic effect of preoperative 3D printing design combined with minimally invasive percutaneous plate internal fixation for the treatment of middle and lower tibiofibular fractures

作　　者：朱成栋[1] 夏建忠[1] 乔高山[1] 朱乐银[1] 黄华[1] 钱俊[1] 夏正荣[1] 顾英俊 Zhu Chengdong;Xia Jianzhong;Qiao Gaoshan;Zhu Leyin;Huang Hua;Qian Jun;Xia Zhengrong;Gu Yingjun(Department of Trauma and Orthopaedics,the People's Hospital of Yizheng,Affiliated Yizheng Hospital of Yangzhou University Medical College,Yizheng 211400,China)

机构地区：[1]江苏省仪征市人民医院(扬州大学医学院附属仪征医院)创伤骨科,211400

出　　处：《中华解剖与临床杂志》2019年第5期477-482,共6页Chinese Journal of Anatomy and Clinics

摘　　要：目的探讨术前3D打印设计结合微创经皮钢板内固定技术治疗胫骨中下段骨折的临床疗效.方法回顾性分析2012年1月—2017年6月仪征市人民医院骨科收治的胫骨中下段骨折110例患者的临床资料.110例中,术前3D打印设计结合微创经皮钢板内固定技术48例(3D打印组),其中男28例、女20例,年龄为19~68(42.5±5.7)岁,左侧17例、右侧31例;AO/OTA分型A型11例、B型19例、C型18例;采用常规切开复位内固定(ORIF)技术62例(ORIF组),其中男34例、女28例,年龄21~72(44.7±7.5)岁,左侧25例、右侧37例,AO/OTA分型A型16例、B型22例、C型24例.记录并分析两组患者切口长度、手术出血量、术中X线曝光次数、住院时间、骨折愈合时间、踝关节功能优良率以及并发症发生率等.结果所有患者随访12.0~18.0(13.6±2.5)个月.3D打印组和ORIF组患者的切口长度(胫骨累计切口长度)分别为(7.57±1.63)和(12.7±2.73)cm、出血量分别为(45.7±10.5)和(120.3±17.9)mL、住院时间分别为(10.3±3.17)和(13.9±3.43)d、X线曝光次数分别为(3.07±2.13)和(1.46±1.85)次、骨折愈合时间分别为(4.2±2.65)和(5.9±2.32)个月,3D打印组较ORIF组有明显优势,差异均有统计学意义(P值均<0.05).3D打印组和ORIF组踝关节Johner-Wruhs功能评分分别是优27例、良17例、可4例和优25例、良24例、可11例、差2例,差异有统计学意义(Z=2.555,P<0.05);并发症发生率分别为0(0/48)和4.8%(3/62),差异无统计学意义(χ2=0.912,P>0.05).结论术前3D打印设计结合微创经皮钢板内固定技术治疗胫骨中下段骨折可术前进行充分评估,既具有创伤小、出血少等微创特点,又能促进骨折愈合,改善踝关节功能等作用.Objective To explore the clinical application of preoperative 3D printing design combined with minimally invasive percutaneous plate internal fixation(MIPPO)in the treatment of middle and lower tibiofibular fractures.Methods Retrospective analysis of clinical data of 110 patients with fractures of the middle and lower tibia in the Department of Orthopaedics,Yizheng People's Hospital from January 2012 to June 2017.Preoperative 3D printing design combined with minimally invasive percutaneous plate internal fixation technology(3D printing group)was performed in 48 patients,including 28 males and 20 females,17 on the left and 31on the right,aged from 19 to 68(42.5±5.7)years.According to AO/OTA classification,there were 11 patients of type A,19 patients of type B,and 18 patients of type C.Open reduction and internal fixation(ORIF group)was used in 62 patients,including 34 males and 28 females;25 on the left and 37 on the right.aged from 21 to 72(44.7±7.5)years.According to AO/OTA classification,there were 16 patients of type A,22 patients of type B,and 24 patients of type C.The operation data such as incision length,the amount of bleeding,the X-ray exposure times,the hospitalization time,the fracture healing time,excellent and good rate of ankle joint function and incidence of complications were recorded and analyzed.Results All patients were followed up for 12.0 to 18.0(13.6±2.5)months.The length of the incision(the cumulative length of the tibia)in the 3D print group and the ORIF group were(7.57±1.63)cm and(12.7±2.73)cm.The amount of bleeding were(45.7±10.5)mL and(120.3±17.9)mL,respectively.The hospitalization time of the two groups were(10.3±3.17)d and(13.9±3.43)d,respectively.The X-ray exposure times were(3.07±2.13)times and(1.46±1.85)times,respectively.The fracture healing time were(4.2±2.65)months and(5.9±2.32)months,respectively.The functional scores of the ankle joint Johner-Wruhs in the 3D print group and the ORIF group were excellent in 27 patients,good in 17 patients,fair in 4 patients,and exce

关 键 词：胫骨骨折 骨折固定术 内 3D打印技术 外科手术 微创性 

分 类 号：R68[医药卫生—骨科学]