骨盆后环损伤3D打印导板辅助骶髂螺钉固定  

3D printed guide assisted sacroiliac screw fixation for pelvic posterior ring injury

作　　者：李文龙 刘振兴 孙兆云 王星 LI Wen-long;LIU Zhen-xing;SUN Zhaoyun;WANG Xing(People's Hospital of Jinan City,Shandong First Medical University,Jinan 271100,China)

机构地区：[1]山东第一医科大学附属人民医院,山东济南271100

出　　处：《中国矫形外科杂志》2024年第10期889-894,共6页Orthopedic Journal of China

基　　金：2021年度山东省老年医学学会科技攻关计划项目(编号:LKJGG2021W056)。

摘　　要：[目的]探究应用3D打印导板辅助骶髂螺钉固定在骨盆后环损伤中的临床价值。[方法]回顾性分析2020年1月—2023年2月收住本院创伤骨科病区中心的45例骨盆后环损伤患者的临床资料,依据术前医患沟通结果,21例采用3D导板辅助,24例采用徒手置钉。比较两组围手术期、随访和影像资料。[结果]导板组手术时间[(84.8±2.6)min vs(113.3±2.2)min,P<0.001]、螺钉置入时间[(40.9±0.4)min vs(65.3±1.6)min,P<0.001]、导针调整次数[(0.8±0.7)次vs(4.0±0.9)次,P<0.001]和X线曝光时间[(35.2±0.8)s vs(77.3±1.4)s,P<0.001]均显著优于徒手组。随访时间平均(24.1±7.5)个月。导板组患者完全负重活动时间[(85.6±2.7)d vs(95.1±0.6)d,P=0.046]显著早于徒手组。与术后1个月相比,末次随访时,两组患者VAS评分、髋伸屈和内外旋ROM、Majeed评分均显著改善(P<0.05)。术后1个月,导板组VAS评分[(2.6±0.3)vs(3.7±0.2),P=0.042]、髋伸-屈ROM[(121.2±1.1)°vs(103.2±1.6)°,P=0.046]和髋内外旋ROM[(78.0±0.5)°vs(55.5±0.9)°,P<0.001]、Majeed评分[(36.5±2.3)vs(26.8±0.3),P<0.001]均显著优于徒手组。影像方面,导板组置钉位置[优/良/差,例(%),19(90.4)/1(4.8)/1(4.8)vs 14(58.3)/7(29.2)/3(12.5),P<0.001]、骨折复位质量[优/良/差,例(%),18(85.7)/2(9.5)/1(4.8)vs 11(45.8)/9(37.5)/4(16.7),P<0.001]、骨折愈合时间[<10周/10~16周/≥16周,例(%),17(80.9)/3(14.3)/1(4.8)vs 11(45.8)/10(41.7)/3(12.5),P<0.001]显著优于徒手组。[结论]3D打印导板辅助骶髂螺钉固定骨盆后环骨折损伤小,可以取得更佳的早期治疗效果。[Objective]To explore the clinical value of using 3D printed guide to assist sacroiliac screw fixation in the treatment of pel⁃vic posterior ring injury.[Method]A retrospective analysis was conducted on the clinical data of 45 patients with pelvic posterior ring inju⁃ry admitted to the trauma orthopedic ward center of our hospital from January 2020 to February 2023.Based on preoperative doctor-patient communication results,21 patients were assisted with 3D guide,while 24 patients were treated with screw placement by freehand tech⁃nique.The perioperative,follow-up,and imaging data were compared between the two groups.[Results]The 3D group proved significantly superior to the freehand group in terms of surgical time[(84.8±2.6)min vs(113.3±2.2)min,P<0.001],screw insertion time[(40.9±0.4)min vs(65.3±1.6)min,P<0.001],number of screw adjustments[(0.8±0.7)times vs(4.0±0.9)times,P<0.001],and X-ray exposure time[(35.2±0.8)s vs(77.3±1.4)s,P<0.001].The average follow-up period lasted for(24.1±7.5)months,and the 3D group resumed full weight-bearing activity significantly earlier than the freehand group[(85.6±2.7)days vs(95.1±0.6)days,P=0.046].Compared with those one month after surgery,both groups of patients showed significant improvements in VAS score,hip extension and flexion,internal-external rotation ROM,and Majeed score at the last follow-up(P<0.05).The 3D group proved significantly better than the freehand group in terms of VAS score[(2.6±0.3)vs(3.7±0.2),P=0.042],hip extension flexion ROM[(121.2±1.1)°vs(103.2±1.6)°,P=0.046],hip internal and external rotation ROM[(78.0±0.5)°vs(55.5±0.9)°,P<0.001],and Majeed score[(36.5±2.3)vs(26.8±0.3),P<0.001]1 month postoperatively,whereas the dif⁃ferences in aforesaid items became not significant between the two groups since then(P>0.05).Radiographically,the 3D group was also sig⁃nificantly better than the freehand group in terms of accuracy of screw placement[cases(%)][excellent/good/poor,19(90.4)/1(4.8)/1(4.8)vs 14(58.3)/7(29.2)/3(12.5),P<0.001],fr

关 键 词：骨盆骨折 3D打印 骶髂螺钉 回顾性研究 

分 类 号：R683.3[医药卫生—骨科学]