改良经皮三维打印导板与传统透视辅助骶髂螺钉固定骨盆后环骨折的疗效比较  

Efficacy comparison between iliosacral screw fixation of the posterior pelvic ring fracture with the assistance of modified percutaneous three-dimensional printing guide template and conventional fluoroscopy

作　　者：刘峰 雷青 蔡立宏 蒋明辉 阳宏奇 王康 丁州 刘文前 LIU Feng;LEI Qing;CAI Lihong;JIANG Minghui;YANG Hongqi;WANG Kang;DING Zhou;LIU Wenqian(Department of Orthopedics,Third Hospital of Changsha,Changsha 410015;3D Printing Technology Medical Application Research Institute of Changsha,Changsha 410015;Department of Radiology,Third Hospital of Changsha,Changsha 410015,China)

机构地区：[1]长沙市第三医院骨科,长沙410015 [2]长沙市3D打印技术医学应用研究所,长沙410015 [3]长沙市第三医院医学影像科,长沙410015

出　　处：《中南大学学报（医学版）》2023年第11期1703-1710,共8页Journal of Central South University ：Medical Science

基　　金：湖南省科技创新计划(2018SK52401,2020SKC2006);湖南省卫生和计划生育委员会科研计划(B2016223)。

摘　　要：目的:三维打印(以下简称“3D打印”)贴骨导板辅助空心螺钉固定骨盆骨折疗效可靠,但安装导板时需要较广泛的软组织剥离。本研究旨在比较改良经皮3D打印导板与传统透视下辅助骶髂螺钉植入治疗骨盆后环骨折的临床效果。方法:收集2019年5月至2021年9月诊治的骨盆后环骨折患者28例,并随机分为2组。导板组采用改良经皮导板辅助骶髂螺钉固定骨盆后环骨折;透视组采用透视辅助骶髂螺钉固定骨盆后环骨折。记录2组每枚螺钉植入的手术时间、透视次数、术中出血量和切口长度。根据Matta标准评价骨折复位情况,分别按照改良Gras分类和Majeed功能评分系统评估螺钉位置和患者功能恢复情况,并进行统计学分析。结果:28例患者均获随访12~24个月,其中导板组14例患者植入15枚骶髂螺钉,透视组14例患者植入14枚骶髂螺钉。导板组和透视组手术时间分别为20~30(25.8±2.8)min和30~60(48.1±7.5)min(P<0.001),透视次数分别为9~15(12.2±1.9)和40~96(64.7±16.3)(P<0.001),螺钉偏移分别为2~4(2.6±0.7)mm和3~6(4.2±0.9)mm(P<0.001),切口长度分别为4~5(4.6±0.5)cm和0.8~1.2(1.0±0.1)cm(P<0.001),术中出血量分别为5~10(7.8±1.7)mL和2~5(3.1±1.3)mL(P<0.001)。2组骨折复位Matta标准评分均达到优、良(P=0.584)。改良Gras分类评估螺钉位置:导板组I类12枚,II类3枚,III类0枚;透视组I类10枚,II类3枚,III类1枚。2组比较差异无统计学意义(P=0.334)。末次随访Majeed功能评分导板组与透视组比较差异无统计学意义(P=0.908)。结论:改良经皮3D打印导板辅助骶髂螺钉固定骨盆后环骨折对比传统透视辅助骶髂螺钉固定骨盆后环骨折可缩短手术时间,减少透视次数,提高植钉的准确性。Objective:The effect of three-dimensional(3D)printed bone-attached guide plate assisted cannulated screw fixation of pelvic fracture is reliable,but extensive soft tissue dissection is still required when installing the guide plate.This study aims to compare the efficacy of posterior pelvic ring fracture fixation with iliosacral screw insertion between the assistance of modified percutaneous patient specific 3D printed guide template and conventional fluoroscopy.Methods:From May,2019 and September 2021,28 patients sustained posterior pelvic ring fractures were randomized into 2 groups:A guide template group,in which the iliosacral screw was inserted for fixation of the posterior pelvic ring fracture with the assistance of modified percutaneous patient specific 3D printed guide template,and a fluoroscopy group,in which the iliosacral screw was inserted under the guidance of conventional fluoroscopy.The operation time,fluoroscopic frequency,intraoperative blood loss,and incision length were recorded for each screw insertion.Fracture reduction was evaluated according to the Matta criteria.The screw position was evaluated according to the modified Gras classification,and the functional outcome was evaluated according to Majeed score.The parameters of both groups were compared,and statistical analysis was performed.Results:All the 28 patients were followed up for 12−24 months.Of them,15 iliosacral screws were inserted in 14 patients in the guide template group,and 14 iliosacral screws were inserted in 14 patients in the fluoroscopy group.The operation time,fluoroscopic frequency,screw deviation,incision length,and blood loss in the guide template group were 20−30(25.8±2.8)min,9−15(12.2±1.9),2−4(2.6±0.7)mm,4−5(4.6±0.5)cm,and 5−10(7.8±1.7)mL,respectively,whereas those in the fluoroscopy group were 30−60(48.1±7.5)min,40−96(64.7±16.3),3−6(4.2±0.9)mm,0.8−1.2(1.0±0.1)cm,and 2−5(3.1±1.3)mL,respectively,and there were statistical significance(all P<0.001).Fracture reduction was evaluated accord

关 键 词：骨盆 骨折固定术 三维打印 导板 骶髂螺钉 

分 类 号：R687.3[医药卫生—骨科学]