3D打印辅助手术对复杂股骨转子间骨折患者术后功能恢复及血清ALP、BMP-2、TGF-β1表达影响  

Effects of 3D printing assisted operation on postoperative functional recovery and serum ALP, BMP-2 and TGF-β expression in patients with complex intertrochanteric fractures

作　　者：田元 张昊[1] 李高峰[1] 庞杰[1] 杨永明[1] 袁伟东[1] TIAN Yuan;ZHANG Hao;LI Gao-feng;PANG Jie;YANG Yong-ming;YUAN Wei-dong(Department of Orthopedics,Baoding Second Hospital,Baoding 071051,HeBei,China)

机构地区：[1]保定市第二医院骨一科,河北保定071051

出　　处：《生物医学工程与临床》2021年第3期291-296,共6页Biomedical Engineering and Clinical Medicine

基　　金：保定市科技支撑计划项目(17ZF320)。

摘　　要：目的探讨3D打印辅助手术对复杂股骨转子间骨折患者术后功能恢复及血清碱性磷酸酶(ALP)、骨形态发生蛋白-2(BMP-2)和转化生长因子-β1(TGF-β1)表达影响。方法选择120例股骨转子间骨折患者,其中男性53例,女性67例;年龄65~80岁,平均年龄72.53岁;体质量50~75 kg,平均体质量62.95 kg;交通事故伤45例,摔伤75例;骨折埃文斯(Evans)分型,Ⅲ型63例,Ⅳ型40例,V型17例;合并高血压66例,糖尿病32例,骨质疏松29例,肺源性心脏病14例。按随机数字表法分为观察组和对照组,各60例。对照组采用传统股骨近端防旋髓内钉(PFNA)治疗,观察组采用3D打印技术辅助PNFA手术治疗。对比两组手术时间、术中透视次数、术中出血量、术后引流量,术前及术后3个月、12个月哈里斯(Harris)评分、巴塞尔(Barthel)指数,术后即刻、术后3个月及6个月血清ALP、BMP-2、TGF-β1水平和术后并发症。结果观察组手术时间、术中透视次数、术中出血量、术后引流量及骨折愈合时间均显著少于对照组(P <0.01)。两组患者术后Harris评分均呈上升趋势,观察组术后3个月Harris评分高于对照组[(84.36±2.58)分vs (81.17±2.42)分;P <0.01],术后12个月两组患者Harris评分差异无统计学意义(P> 0.05)。两组患者术前Barthel指数比较,差异无统计学意义(P> 0.05);术后3个月观察组Barthel指数高于对照组(83.38分±5.52分vs 80.66分±5.65分;P <0.01);而两组患者术后12个月Barthel指数差异无统计学意义(P> 0.05)。两组患者术后3个月及6个月血清ALP、BMP-2、TGF-β1水平均呈上升趋势(P <0.05);观察组术后3个月及6个月血清ALP、BMP-2、TGF-β1水平均明显高于对照组,差异具有统计学意义(P <0.05)。观察组术后并发症发生率虽然低于对照组(6.67%vs 10.00%),但差异无统计学意义(P> 0.05)。结论 3D打印辅助技术辅助PFNA手术治疗复杂股骨转子间骨折可以缩短手术时间,减少术中透视次数和出血量,可以�Objective To investigate the effects of three-dimensional(3 D) printing assisted operation on postoperative functional recovery and serum level of alikaline phosophatase(ALP), bone morphogenetic protein-2(BMP-2), transforming growth factor-β1(TGF-β1) in patients with complex intertrochanteric fractures. Methods A total of 120 patients with intertrochanteric fractures were enrolled, which included 53 males and 67 females, aged 65-80 years old with mean age of 72.53 years old;body mass was 50-75 kg with mean body mass of 62.95 kg;45 cases of traffic accident injuries and 75 of fall injuries;fracture Evans classification: 63 cases of type Ⅲ, 40 cases of type Ⅳ and 17 cases of type Ⅴ;combined with hypertension in 66 cases, diabetes in 32, osteoporosis in 29 and pulmonary heart disease in 14. According to random number table, all of them were divided into observation group[n = 60, treatment with 3 D printing assisted proximal femoral anti-rotation intramedullary(PNFA) operation] and control group(n = 60, treatment with PFNA). The operative time, intraoperative fluoroscopy numbers, intraoperative blood loss, postoperative drainage volume, Harris scores and Barthel index of before operation and 3-, 12-month after operation, serum ALP, BMP-2 and TGF-β1 levels 3-, 6-month after operation, and postoperative complications of 2 groups were compared and analyzed. Results The operative time, intraoperative fluoroscopy numbers, intraoperative blood loss, postoperative drainage volume and fracture healing time of observation group were significantly less than control group(P <0.01). The postoperative Harris scores of 2 groups were increased, and Harris scores of 3-month post operation in observation group was significantly higher than in control group[(84.36 ± 2.58) scores vs(81.17 ± 2.42) scores;P < 0.01]. However, there was no significant difference in Harris scores 12-month post operation between 2 groups(P > 0.05). There was no statistical difference in Barthel index before operation between 2 groups(P > 0.05). Ne

关 键 词：3D打印技术 股骨转子间骨折 日常生活活动 碱性磷酸酶(ALP) 骨形态发生蛋白-2(BMP-2) 转化生长因子-β1(TGF-β1) 

分 类 号：R683.42[医药卫生—骨科学] R318[医药卫生—外科学]