3D打印导板引导下经皮逆行耻骨上支螺钉内固定治疗Ⅱ型老年脆性骨盆骨折  

Internal fixation of percutaneous screws of retrograde suprapubic ramus guided by 3D printing template for typeⅡfragility fractures of the pelvis in the elderly

作　　者：廖雄[1] 邓俭良 尤迪 Liao Xiong;Deng Jianliang;You Di(Department of Orthopedic Trauma,The Affiliated Changsha Central Hospital(Changsha Central Hospital),Hengyang Medical School,University of South China,Changsha 410004,Hunan,China)

机构地区：[1]南华大学附属长沙中心医院(长沙市中心医院)创伤骨科,湖南长沙410004

出　　处：《中国现代手术学杂志》2023年第1期38-43,共6页Chinese Journal of Modern Operative Surgery

基　　金：湖南省临床医疗技术创新引导项目(2020SK53308);湖南省卫生健康委科研计划项目(202204073531)。

摘　　要：目的探讨3D打印导板引导下经皮逆行耻骨上支螺钉内固定治疗FFPⅡ型老年脆性骨盆骨折的临床疗效。方法回顾性分析我院2021年1月至2022年6月采用个体化设计3D打印导板引导下行经皮逆行耻骨上支螺钉内固定治疗的20例FFPⅡ型老年脆性骨盆骨折患者的临床资料,平均年龄(69.0±5.3)岁。记录手术时间、术中失血量、术中透视次数、骨折愈合时间及手术并发症,采用视觉模拟评分(VAS)进行疼痛评分,采用Majeed功能评分标准进行骨盆功能评价。结果本组20例患者均顺利完成手术,手术时间(21.4±4.3)min,术中失血量(3.7±1.6)mL。术中透视(2.5±1.1)次。入院时VAS评分平均(7.2±1.4)分,术后第1 d改善为(5.1±1.8)分。所有患者随访6~24个月,平均(14.7±5.4)个月。骨折均愈合,愈合时间10~14周,平均(12.1±1.3)周。末次随访Majeed评分78~90分,平均(89.0±5.1)分,其中优18例,良2例,优良率100%。均未出现围术期并发症,随访期间无螺钉松动、断裂。结论基于三维CT个体化数据设计的3D打印导板操作简单,导向精准,在其引导下行经皮逆行耻骨上支螺钉内固定治疗FFPⅡ型老年脆性骨盆骨折创伤小,手术安全性高,可早期缓解疼痛,促进患者快速康复。Objective To evaluate the clinical effect of internal fixation of percutaneous screws of retrograde suprapubic ramus guided by 3D printing guide template for typeⅡfragility fractures of the pelvis(FFP)in the elderly.Methods A retrospective analysis was performed on the clinical data of 20 aged patients with typeⅡFFP treated by internal fixation of percutaneous screws of retrograde suprapubic ramus under the guidance of individual designed 3D printing guider in our hospital from January 2021 to June 2022.The operation time,blood loss and fluoroscopy times of intra-operation,fracture healing time and complications were observed.Visual analog scale(VAS)was used to evaluate the degree of pain,and Majeed function score was to evaluate the pelvic function.Results All 20 patients completed the operation successfully with the operation time of 21.4±4.3 min,intra-operative blood loss of 3.7±1.6 mL,and intra-operative fluoroscopy times of 2.5±1.1.The VAS score was improved from 7.2±1.4(at admission)to 5.1±1.8(the first day after the operation).All patients were followed up for 6 to 24 months with an average of 14.7±5.4 months.All fractures achieved healing during 10 to 14 weeks(mean,12.1±1.3).At the last follow-up,Majeed scores ranged from 78 to 90 points(mean,89±5.1),and the pelvic function revealed excellent in 18 cases and good in 2 cases,and the fineness rate was 100%.No peri-operative complications,screw loosening or broken were found during the follow-up.Conclusion The 3D printing guide template designed based on individual CT data and printed with 3D printing technique is simple and accurate in the guidance of internal fixation with percutaneous screws of retrograde suprapubic ramus for typeⅡFFP with advantages of mini-trauma,high safety,early pain-relief and improving fast recovery.

关 键 词：骨盆骨折 骨折固定术 通道螺钉 3D打印导板 老年人 

分 类 号：R687.3[医药卫生—骨科学]