3D打印技术辅助经皮撬拨复位空心钉内固定治疗跟骨骨折  

Percutaneous leverage reduction and hollow screws internal fixation assisted by 3D printing technology for treatment of calcaneus fractures

作　　者：邓雄伟[1] 万治平 胡和军[1] DENG Xiongwei;WAN Zhiping;HU Hejun(Nanchang Hongdu Hospital of Traditional Chinese Medicine,Nanchang 330038,Jiangxi,China)

机构地区：[1]南昌市洪都中医院,江西南昌330038

出　　处：《中医正骨》2020年第9期12-17,共6页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：江西省卫生计生委科技计划项目(20194016);南昌市指导性科技计划项目(洪科发计字[2018]39号)。

摘　　要：目的:探讨3D打印技术辅助经皮撬拨复位空心钉内固定治疗跟骨骨折的临床疗效。方法:跟骨骨折患者60例,随机分为3D打印组和常规术式组,每组30例。2组均采用经皮撬拨复位空心钉内固定手术治疗。3D打印组,术前采用3D打印技术打印患足3D模型,详细了解骨折情况,制定手术计划,确定骨折复位的撬拨点和螺钉植入位置、方向、长度,并按计划进行手术操作。常规术式组,按经皮撬拨复位空心钉内固定常规术式进行手术操作。记录2组患者手术时间、术中X线透视次数及骨折愈合时间。分别于术前、术后即刻及术后6个月在X线片上测量患足Bohler角和Gissane角。术后6个月,参照Maryland足功能评分标准评价疗效。结果:2组患者均顺利完成手术,3D打印组与常规术式组相比,手术时间短、术中透视次数少[(50.30±7.63)min,(61.47±8.29)min,t=-5.170,P=0.000;(7.03±2.02)次,(12.36±3.15)次,t=-13.493,P=0.000]。2组患者均获随访,随访时间6~12个月,中位数10个月;骨折均愈合,3D打印组骨折愈合时间较常规术式组短[(11.5±1.3)周,(12.5±1.5)周,t=-10.265,P=0.000]。2组患者手术前后不同时间点间患足Bohler角(3D打印组:6.28°±2.40°,29.50°±2.50°,29.30°±2.65°;常规术式组:6.30°±2.38°,28.60°±2.48°,28.30°±2.30°)、Gissane角(3D打印组:96.30°±4.86°,132.50°±4.68°,132.44°±4.66°;常规术式组:96.50°±4.82°,131.50°±4.60°,131.90°±4.40°)总体比较,差异均有统计学意义,即均存在时间效应(F=94.404,P=0.000;F=55.860,P=0.000);2组患者患足Bohler角、Gissane角组间总体比较,差异均无统计意义,即均不存在分组效应(F=1.086,P=0.302;F=5.769,P=0.068);时间因素和分组因素均无交互效应(F=1.686,P=0.190;F=5.026,P=0.072)。术后6个月参照Maryland足功能评分标准评价疗效,3D打印组优13例、良12例、可3例、差2例,常规术式组优10例、良11例、可6例、差3例;2组患者临床疗效的组间差异无统计�Objective:To explore the clinical curative effects of percutaneous leverage reduction and hollow screws internal fixation assisted by 3 D printing technology for treatment of calcaneus fractures.Methods:Sixty patients with calcaneus fractures were enrolled in the study and were randomly divided into 3 D printing group and conventional surgery group,30 cases in each group.All patients in the 2 groups were treated with percutaneous leverage reduction and hollow screws internal fixation.For patients in 3 D printing group,the 3 D models of injured feet were printed by using 3 D printing technology before the surgery for detailed understanding of fractures,making surgical plan and confirming the leverage point during fracture reduction and the position,direction and length of implanted screws,and then the surgeries were performed according to the designed surgical plan.The patients in conventional surgery group were merely treated with conventional percutaneous leverage reduction and hollow screws internal fixation.The operative time,intraoperative X-ray exposure and fracture healing time were recorded and compared between the 2 groups.The Bohler angle and Gissane angle of injured foot were measured on X-ray films before the surgery,immediately after the surgery and at 6 months after the surgery respectively.The clinical curative effects were evaluated according to Maryland foot function scoring standard at 6 months after the surgery.Results:The surgeries were finished successfully in all patients.The operative time was shorter and the intraoperative X-ray exposure was fewer in 3 D printing group compared to conventional surgery group(50.30+/-7.63 vs 61.47+/-8.29 min,t=-5.170,P=0.000;7.03+/-2.02 vs 12.36+/-3.15 times,t=-13.493,P = 0. 000). All patients in the 2 groups were followed up for 6-12 months with a median of 10 months. All fractures healed in the2 groups,and the fracture healing time was shorter in 3 D printing group compared to conventional surgery group( 11. 5 +/-1. 3 vs12. 5 +/-1. 5 weeks,t =-10. 265,P = 0

关 键 词：骨折 跟骨 骨折固定术 内 三维打印 

分 类 号：R687.3[医药卫生—骨科学]