3D打印技术辅助与常规切开复位内固定治疗多发肋骨骨折的疗效比较  

Efficacy comparison of 3D printing technology-assisted and conventional open reduction and internal fixation for multiple rib fracture

作　　者：李杰实 陈前顺[2] 徐驯宇[3] 卓宜盟 李忠 黄郴[2,3] 赵力澜 Li Jieshi;Chen Qianshun;Xu Xunyu;Zhuo Yimeng;Li Zhong;Huang Chen;Zhao Lilan(Department of Thoracic Surgery,Mindong Hospital Affiliated to Fujian Medical University,Fuan 355000,China;Fujian Medical University Provincial Clinical Medical College,Fuzhou 350001,China;Department of Thoracic Surgery,FujianProvincial Hospital,Fuzhou350001,China)

机构地区：[1]福建医科大学附属闽东医院胸外科,福安355000 [2]福建医科大学省立临床医学院,福州350001 [3]福建省立医院胸外科,福州350001

出　　处：《中华创伤杂志》2022年第11期985-991,共7页Chinese Journal of Trauma

摘　　要：目的比较3D打印技术辅助与常规切开复位内固定治疗多发肋骨骨折的疗效。方法采用回顾性队列研究分析2018年7月至2020年3月福建医科大学附属闽东医院和福建省立医院收治的61例多发肋骨骨折患者临床资料,其中男44例,女17例;年龄18~73岁[(45.1±12.9)岁]。单侧肺挫裂伤31例,双侧肺挫裂伤30例。合并血气胸19例,连枷胸16例。31例接受3D打印技术辅助切开复位内固定术(3D辅助切开组),30例接受常规切开复位内固定术(常规切开组)。比较两组切口长度、手术时间、术中出血量、术后3 d视觉模拟评分(VAS)、疼痛持续时间、胸管留置时间、总住院时间、术后骨痂形成时间、肋骨接骨板松脱率,以及术前、术后6个月、末次随访时健康状况调查简表(SF-36)评分(包括:生理功能、生理职能、躯体疼痛、总健康状况、精力、社会功能、情感职能、精神健康)。观察并发症发生情况。结果患者均获随访18~38个月[(26.4±5.5)个月]。3D辅助切开组切口长度为(5.9±1.3)cm,手术时间为(84.6±7.8)min,术中出血量为(85.5±13.9)ml,术后3 d VAS为(2.5±0.5)分,疼痛持续时间为(5.9±0.7)d,胸管留置时间为(3.4±0.7)d,总住院时间为(7.0±1.0)d,术后骨痂形成时间为(2.6±0.7)周,肋骨接骨板松脱率为3.2%(1/31);常规切开组切口长度为(10.9±2.4)cm,手术时间为(127.1±12.5)min,术中出血量为(183.0±30.9)ml,术后3 d VAS为(6.5±0.9)分,疼痛持续时间为(11.2±1.8)d,胸管留置时间为(7.8±0.8)d,总住院时间为(15.1±1.2)d,术后骨痂形成时间为(4.6±0.8)周,肋骨接骨板松脱率为20.0%(6/30)(P<0.05或0.01)。两组术前SF-36各项评分差异无统计学意义(P>0.05)。术后6个月3D辅助切开组除"精神健康"外,SF-36其余各项评分高于常规切开组(P<0.05或0.01);末次随访时3D辅助切开组SF-36各项评分高于常规切开组(P<0.05或0.01)。术后均无明显肺部感染、肺不张等并发症。结论相比常规切开�Objective:To compare the efficacy of 3D printing technology-assisted and conventional open reduction and internal fixation of multiple rib fracture.Methods:A retrospective cohort study was conducted to analyze the clinical data of 61 patients with multiple rib fracture admitted to Mindong Hospital Affiliated to Fujian Medical University and Fujian Provincial Hospital from July 2018 to March 2020.There were 44 males and 17 females,with age range of 18-73 years[(45.1±12.9)years].Unilateral lung contusion and laceration occurred in 31 patients,while bilateral in 30.There were 19 patients accompanied by hempneumothorax and 16 by flail chest.Totally,31 patients received 3D printing technology assisted open reduction and internal fixation(3D-assisted incision group)and 30 patients received conventional open reduction and internal fixation(conventional incision group).The incision length,operation time,intraoperative blood loss,postoperative 3-day visual analogue scale(VAS),duration of pain,indwelling time of chest tube,total length of hospital stay,postoperative bone callus formation time and rate of rib bone plate loosening were comapared in two groups.The short form 36 health survey(SF-36)score(ie,physical function,physical function,physical pain,general health,energy,social function,emotional function,mental health)preoperatively,at postoperative 6-month and at the last follow-up was compareted between two groups.Complications were observed at the same time.Results:All patients were followed up for 18-38 months[(26.4±5.5)months].In 3D-assisted incision group,the incision length was(5.9±1.3)cm,with operation time for(84.6±7.8)minutes,intraoperative blood loss for(85.5±13.9)ml,postoperative 3-day VAS for(2.5±0.5)points,duration of pain for(5.9±0.7)days,indwelling time of chest tube for(3.4±0.7)days,total length of hospital stay for(7.0±1.0)days,postoperative callus formation time for(2.6±0.7)weeks and rate of rib bone plate loosening for 3.2%(1/31).By contrast,in conventional incision group,the incision leng

关 键 词：肋骨骨折 打印 三维 骨折固定术 内 生活质量 

分 类 号：R687.3[医药卫生—骨科学]