3D打印导板经皮螺钉固定腕舟骨腰部骨折  

3D printed guide leading percutaneous screw fixation of waist part fracture of the scaphoid

作　　者：荣存敏[1] 王芳[2] 朱少波 曾俊豪 张高峰 张志[1] 李印龙[3,4] 郭阳 韩清銮[1] RONG Cun-min;WANG Fang;ZHU Shao-bo;ZENG Jun-hao;ZHANG Gao-feng;ZHANG Zhi;LI Yin-long;GUO Yang;HAN Qing-luan(Depart-ment of Hand and Foot Surgery,Affiliated Hospital,Jining Medical College,Jining 272029,China;Intravenous Injection Distribution Center,Affiliated Hospital,Jining Medical College,Jining 272029,China;School of Public Health,Jining Medical University,Jining 272000,China;School of Medicine,Tibet University,Lhasa 850000,China;Department of Hand Surgery,Beijing Jishuitan Hospital,Beijing 102200,China)

机构地区：[1]济宁医学院附属医院手足外科,山东济宁272029 [2]济宁医学院附属医院静配中心,山东济宁272029 [3]济宁医学院公共卫生学院,山东济宁272000 [4]西藏大学医学院,西藏拉萨850000 [5]北京积水潭医院手外科,北京102200

出　　处：《中国矫形外科杂志》2024年第14期1256-1261,共6页Orthopedic Journal of China

基　　金：山东省中医药科技发展项目(编号:2019-0477,2019-0470);山东省专业学位研究生专业学位案例库项目(编号:2021SDYAL21215);济宁市重点研发计划项目(编号:2020JKNS010,2022YXNS047,2022YXNS062);济宁市重点研发计划(软科学项目)(编号:2021JNZC045);济宁医学院实践教学教育科学研究项目(编号:JYSJ2020B3);山东省医药卫生科技项目(编号:202304070500)。

摘　　要：[目的]探讨3D打印导板辅助掌侧经皮内固定与背侧切开内固定治疗急性腕舟骨腰部骨折的临床疗效。[方法]回顾性分析2018年6月—2021年6月本院收治的22例腕舟骨腰部骨折患者的临床资料,根据医患沟通结果,10例采用3D打印导板辅助经皮内固定术(导板组),12例行背侧切开内固定术(常规组)。比较两组围手术期、随访及影像结果。[结果]两组患者均顺利完成手术,导板组手术时间[(39.9±5.5)min vs(108.8±13.7)min,P<0.001]、切口总长度[(0.5±0.5)cm vs(5.9±0.9)cm,P<0.001]、术中失血量[(0.9±0.4)ml vs(7.8±2.0)ml,P<0.001]、术中透视次数[(5.4±1.2)次vs(13.4±3.0)次,P<0.001]、住院时间[(4.8±1.0)d vs(7.2±1.4)d,P<0.001]以及术后7 d的VAS评分[(2.0±1.1)vs(3.5±1.0),P=0.003]均显著优于常规组。随访时间5~27个月,导板组完全负重活动时间显著早于常规组[(7.0±1.3)周vs(8.6±1.8)周,P=0.031]。末次随访时导板组Mayo评分[(95.5±5.0)vs(83.3±5.4),P<0.001]、腕掌屈-背伸ROM[(146.8±6.8)°vs(108.0±7.6)°,P<0.001]、腕尺偏-桡偏ROM[(32.0±4.4)°vs(19.9±3.1)°,P<0.001]、握力[(35.2±3.0)kg vs(29.8±5.3)kg,P=0.008]均显著优于常规组。影像方面,两组骨折愈合时间的差异无统计学意义(P>0.05)。两组均无内固定装置断裂、脱出、松动情况。[结论]3D打印导板辅助掌侧经皮内固定较背侧切开复位内固定治疗舟骨骨折,骨折愈合快,握力恢复好,腕关节功能恢复好。[Objective]To investigate the clinical efficacy of 3D-printed guide leading palmar percutaneous screw fixation versus rou⁃tine open fixation through dorsal incision for acute waist part fracture of the wrist scaphoid.[Methods]A retrospective research was done on 22 patients who received surgical fixation of scaphoid fracture at the waist part in our hospital from June 2018 to June 2021.According to the doctor-patient discussion,10 patients underwent 3D printed guide leading percutaneous screw fixation(the guide group),while other 12 patients were treated with routine open fixation through dorsal incision(the routine group).Data of perioperative period,follow-up and images were compared between the two groups.[Results]All patients in both cohorts had operation performed successfully.The guide group proved significantly superior to the routine group in terms of operation time[(39.9±5.5)min vs(108.8±13.7)min,P<0.001],the total incision length[(0.5±0.5)cm vs(5.9±0.9)cm,P<0.001],intraoperative blood loss[(0.9±0.4)ml vs(7.8±2.0)ml,P<0.001],intraoperative flu⁃oroscopy times[(5.4±1.2)times vs(13.4±3.0)times,P<0.001],hospital stay[(4.8±1.0)days vs(7.2±1.4)days,P<0.001],and VAS score 7 days after surgery[(2.0±1.1)vs(3.5±1.0),P=0.003].The follow-up period lasted for 5~27 months,and the guide group resumed full weightbearing activity significantly earlier than the routine group[(7.0±1.3)weeks vs(8.6±1.8)weeks,P=0.031].In addition,the guide cohort was significantly better than the routine group regarding to Mayo score[(95.5±5.0)vs(83.3±5.4),P<0.001],the wrist palmar flexion-dorsal ex⁃tension range of motion(ROM)[(146.8±6.8)°vs(108.0±7.6)°,P<0.001],the ulnar-radial deviation ROM[(32.0±4.4)°vs(19.9±3.1)°,P<0.001],grip strength[(35.2±3.0)kg vs(29.8±5.3)kg,P=0.008]at the latest follow-up.Radiographically,there was no significant difference in fracture healing time between the two groups(P>0.05),and no internal fixation devices broken or loosened were noted in anyone of them.[Conclusion]The 3D-print

关 键 词：3D 打印导板 经皮螺钉固定 腕舟骨 骨折 

分 类 号：R683.41[医药卫生—骨科学]