应用3D打印技术辅助双平面截骨治疗SchatzkerⅣ型胫骨平台骨折畸形愈合  

Biplane osteotomy assisted by 3D printing for malunion of tibial plateau fracture of Schatzker typeⅣ

作　　者：卢斌[1] 王爱国[2] 马富强[2] 陈亚伟[3] Lu Bin;Wang Aiguo;Ma Fuqiang;Chen Yawei(Department of Orthopaedics,Jiaozuo People's Hospital,Jiaozuo,Henan 454002,China;Department of Foot and Ankle Surgery,Zhengzhou Orthopaedics Hospital,Zhengzhou 450052,China;DepartmentⅡof Hand Surgery,Zhengzhou Orthopaedics Hospital,Zhengzhou 450052,China)

机构地区：[1]河南省焦作市人民医院骨科,454002 [2]郑州市骨科医院足踝外科,450052 [3]郑州市骨科医院手外科Ⅱ科,450052

出　　处：《中华创伤骨科杂志》2020年第5期427-431,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨采用3D打印技术辅助双平面截骨治疗SchatzkerⅣ型胫骨平台骨折畸形愈合的临床疗效。方法回顾性分析2014年2月至2018年5月河南省焦作市人民医院骨科和郑州市骨科医院足踝外科收治的19例SchatzkerⅣ型胫骨平台骨折畸形愈合患者资料。男11例,女8例;年龄20~55岁,平均37.6岁;受伤至本次手术时间3~8个月;均采用3D打印技术辅助双平面截骨治疗。记录治疗前、治疗后胫股角、胫骨平台内翻角、后倾角及膝关节Lysholm评分情况,并观察并发症情况。结果所有患者术后获12~28个月(平均18.5个月)随访;骨折愈合时间为12~24周(平均15.5周)。末次随访时患者胫股角173.2°±2.0°、胫骨平台内翻角85.6°±1.3°、后倾角11.9°±1.1°,较术前(154.1°±5.0°、76.0°±1.8°、18.9°±1.6°)均有改善,差异均有统计学意义(P<0.05)。末次随访时Lysholm评分(89.8±1.2)分较术前(52.0±4.4)分有显著改善,差异有统计学意义(P<0.05)。1例患者术后6个月出现行走困难,最终行膝关节置换术。结论采用3D打印技术辅助双平面截骨治疗SchatzkerⅣ型胫骨平台骨折畸形愈合可延缓创伤性关节炎的发展,缓解疼痛,恢复膝关节功能。Objective To evaluate the biplane osteotomy assisted by 3D printing for malunion of tibial plateau fracture of Schatzker typeⅣ.Methods A retrospective study was conducted of the 19 patients with malunion of tibial plateau fracture of Schatzker typeⅣwho had been treated at Department of Orthopaedics,Jiaozuo People's Hospital and Department of Foot and Ankle Surgery,Zhengzhou Orthopaedics Hospital from February 2014 to May 2018.They were 11 males and 8 females,aged from 20 to 55 years(average,37.6 years).The interval from injury to operation ranged from 3 to 8 months.All patients were treated with biplane osteotomy assisted by 3D printing.The tibiofemoral angle,tibial plateau varus angle,posterior tilt angle and Lysholm scores of knee joint were recorded before and after treatment.Postoperative complications were observed.Results All patients were followed up for 12 to 28 months(average,18.5 months).The fracture healing time ranged from 12 to 24 weeks(average,15.5 weeks).At the last follow-up,the patient's tibiofemoral angle was 173.2°±2.0°,tibial plateau varus angle was 85.6°±1.3°,and posterior tilt angle was 11.9°±1.1°,which were higher than the preoperative ones(154.1°±5.0°,76.0°±1.8°,18.9°±1.6°),and the differences were statistically significant(P<0.05).The Lysholm scores at the last follow-up(89.8±1.2)were significantly higher than the preoperative ones(52.0±4.4)(P<0.05).One patient had to receive total knee arthroplasty because of difficult walking 6 months after operation.Conclusion Biplane osteotomy assisted by 3D printing can delay development of traumatic arthritis,relieve pain and restore knee function in the treatment of malunion of tibial plateau fracture of Schatzker typeⅣ.

关 键 词：截骨术 膝关节 骨折 不愈合 3D打印技术 胫骨平台骨折 

分 类 号：R687[医药卫生—骨科学]