3D打印技术辅助手术规划在儿童GartlandⅢ型肱骨髁上骨折治疗中的初步应用  

Preliminary application of three-dimensional printing assisted surgery planning in the treatment of Gartland TypeⅢsupracondylar humeral fracture in children

作　　者：张军 张道平 祝劲松 李亚亚 汪宝磊 陈先进 Zhang Jun;Zhang Daoping;Zhu Jingsong;Li Yaya;Wang Baolei;Chen Xianjin(Department of Pediatric Orthopedics,Wuhu Traditional Chinese Medicine Hospital,Wuhu 241000,China;Anhui University of Chinese Medicine,Hefei 230012,China)

机构地区：[1]芜湖市中医医院儿童骨科,241000 [2]安徽中医药大学,合肥230012

出　　处：《中华小儿外科杂志》2021年第2期126-132,共7页Chinese Journal of Pediatric Surgery

基　　金：安徽省芜湖市科技计划项目(2018cg26)。

摘　　要：目的初步探讨3D打印技术辅助手术规划在儿童GartlandⅢ型肱骨髁上骨折手术治疗中的应用与效果。方法在告知其法定监护人并遵循自愿原则的前提下,根据门、急诊X线片,选择2016年8月至2019年4月收治的新鲜闭合的GartlandⅢ型肱骨髁上骨折患儿40例参与本次研究。其中,男28例,女12例;年龄4~10岁,平均6.1岁;患侧位于左侧25例,右侧15例;手术距受伤时间48~72 h,平均57.8 h。采用随机数字表法,将40例患儿随机分成3D组和对照组,每组20例。其中,3D组患侧肘关节薄层CT扫描数据导入Accumed医学图像处理平台软件中进行骨折三维重建,用3D打印技术制作1∶1大小的肱骨髁上骨折实体模型,在实体模型上直接观察骨折移位情况,进行模拟骨折复位手术,选择最佳进针点及进针角度,并根据术前规划进行手术;对照组采用常规透视下闭合复位加克氏针固定。统计分析两组患儿围手术期一般情况,采用Kolmogorov-Smirnov正态性检验方法对数据进行正态分布性检验,采用两独立样本均数的t检验比较分析术后两组患儿肱骨Baumann角及前倾角的差异,采用卡方检验比较分析术后4周Mayo肘关节功能评分(Mayo elbowperformance score,MEPS)的差异。结果两组患儿年龄、受伤时间、骨折分型、术后Baumann角、前倾角测量结果比较,差异均无统计学意义(P>0.05)。3D组手术时间为(58.50±11.25)min,术中透视次数为(6.85±1.23)次,术中透视时间为(13.70±3.79)min;对照组手术时间为(81.25±13.56)min,术中透视次数为(11.60±1.27)次,术中透视时间为(24.50±3.80)min。3D组在手术时间、术中透视次数和术中透视时间上均较对照组减少,且组间差异均有统计学意义(P均<0.05)。术后4周肘关节功能评分结果比较,3D组的优良率为95%(19/20),对照组为85%(17/20),但差异无统计学意义(P>0.05)。结论3D打印技术从数字化设计转化出真实手术模型,并通过术前在模型实体上Objective To conduct a preliminary study on the application and effect of 3-dimensional printing assisted surgery planning in the treatment of Gartland typeⅢsupracondylar humeral fracture in children.Methods Under the principle of voluntary participation,a total of 40 hospitalized children with recently closed Gartland typeⅢhumeral supracondylar fractures from August 2016 to April 2019 were selected.They were randomly and equally divided into two groups of 3D reconstruction and control(n=20 each).There were 28 boys and 12 girls with an average age of 6.1(4-10)years.The involved side was left(n=25)and right(n=15).The average time from injury to surgery was 57.8(48-72)h.In 3D group,3D computed tomography(CT)scan data of affected elbow joint were imported into Accumed medical image processing platform software for 3D reconstruction of fracture and 3D printing technology was utilized for establishing a 1∶1 suprahumeral fracture solid model.The displacement of fracture was observed on a solid model,simulated fracture reduction performed,optimal point and angle of needles selected and surgery proceeded according to the preoperative plan;control group was fixed with conventional reduction and Kirschner wire fixation under conventional fluoroscopy.Two groups were compared with regards to operative duration,number of intraoperative perspectives,Baumann angle,anteversion measurement and Mayo elbow function score at 4 weeks post-operation.Results No statistically significant inter-group postoperative differences existed in age,injury time,fracture type,Baumann Angle or antegrade inclination(P>0.05).In 3D group,operative duration was(58.50±11.25)min,number of intraoperative fluoroscopy(6.85±1.23)min and intraoperative fluoroscopy time(13.70±3.79)min.In control group,operative duration was(81.25±13.56)min,number of intraoperative fluoroscopy(11.60±1.27)min and intraoperative fluoroscopy time(24.50±3.80)min.Operative duration and frequency/duration of intraoperative fluoroscopy decreased in 3D group as compared wit

关 键 词：儿童 肱骨髁上骨折 3D打印 

分 类 号：R726.8[医药卫生—儿科]