3D打印导板辅助经皮骨水泥增强骶髂螺钉固定治疗老年骨盆脆性骨折  

3D-printed guide plate-assisted percutaneous bone cement-augmented sacroiliac screw fixation for elderly patients with pelvic fragility fractures

作　　者：张博 张贺 史小刚 侯腾 王仁可 杨晶[1] 邱少东[1] Zhang Bo;Zhang He;Shi Xiaogang;Hou Teng;Wang Renke;Yang Jing;Qiu Shaodong(Department of Traumatic Orthopaedics,General Hospital of Ningxia Medical University,Yinchuan 750001,China)

机构地区：[1]宁夏医科大学总医院创伤骨科,银川750001

出　　处：《中华骨科杂志》2024年第22期1482-1488,共7页Chinese Journal of Orthopaedics

基　　金：宁夏重点研发计划项目(2021ZDYF0519)。

摘　　要：目的观察3D打印导板辅助经皮骨水泥增强骶髂螺钉固定治疗老年骨盆脆性骨折应用疗效。方法回顾性分析2022年12月至2024年4月宁夏医科大学总医院创伤骨科接受3D打印导板辅助经皮骨水泥增强骶髂螺钉固定(骨水泥组)的11例老年骨盆脆性骨折患者的临床资料,男3例、女8例,年龄(73.18±4.42)岁(范围67~80岁);骨盆脆性骨折分型:Ⅱ型4例、Ⅲ型7例。选择同期接受3D打印导板辅助经皮骶髂螺钉固定(非骨水泥组)的老年骨盆脆性骨折10例作对照,男5例、女5例,年龄(73.90±6.51)岁(范围67~85岁);骨盆脆性骨折分型:Ⅱ型5例、Ⅲ型5例。比较两组患者的围手术期指标、疼痛视觉模拟评分(visual analogue scale,VAS)、Barthel指数及术后并发症情况。结果所有患者均顺利完成手术并获得随访,随访时间为(17.05±5.48)个月(范围9~27个月)。骨水泥组手术时间和透视次数为(72.09±3.95)min和(12.45±0.93)次,均大于非骨水泥组的(57.00±4.24)min和(8.50±0.97)次,差异有统计学意义(P<0.05)。所有患者骨折均一期愈合,骨水泥组愈合时间为(97.09±7.15)d,非骨水泥组为(103.00±13.14)d,差异有无统计学意义(t=1.297,P=0.210),无一例出现延迟愈合或不愈合。骨水泥组术后负重时间为(44.73±3.72)d,小于非骨水泥组的(59.10±7.37)d,差异有统计学意义(P<0.05)。骨水泥组术后1天、1周、3周的VAS评分分别为(5.73±0.65)分、(4.64±0.51)分、(3.27±0.65)分,均小于非骨水泥组的(6.80±0.42)分、(5.30±0.48)分、(4.00±0.67)分,差异有统计学意义(P<0.05)。骨水泥组术后1天、1周、3周、6周、两个月的Barthel指数均大于非骨水泥组,差异有统计学意义(P<0.05)。骨水泥组2例出现骨水泥渗漏,均未诉特殊不适,未予处理。非骨水泥组2例出现螺钉退出,二次手术取出骶髂螺钉;1例出现骶丛损伤,术后1个月取出螺钉并口服甲钴胺对症治疗,3个月后症状缓解。结论3D打印导板辅助经皮�ObjectiveTo observe the effect of 3D-printed guide plate-assisted percutaneous bone cement-augmented sacroiliac screw fixation in the treatment of pelvic fragility fractures in the elderly.MethodsA total of 11 elderly patients with pelvic fragility fractures who underwent 3D-printed guide plate-assisted percutaneous cement-enhanced sacroiliac screw fixation(cemented group)in the Department of Traumatic Orthopaedics of the General Hospital of Ningxia Medical University from December 2022 to April 2024 were retrospectively analyzed.There were 3 males and 8 females,aged 73.18±4.42 years(range,67-80 years).There were 4 cases of typeⅡand 7 cases of typeⅢ.At the same time,10 elderly patients with pelvic fragility fractures who underwent percutaneous sacroiliac screw fixation assisted by 3D-printed guide plate(cementless group)were selected as control group,including 5 males and 5 females,aged 73.90±6.51 years(range,67-85 years).Pelvic fragility fractures were classified as typeⅡin 5 cases and typeⅢin 5 cases.The perioperative indicators,visual analogue scale(VAS),Barthel index and postoperative complications were compared between the two groups.ResultsAll patients successfully completed the operation and were followed up for 17.05±5.48 months(range,9-27 months).The operation time and fluoroscopy frequency in the bone cement group were 72.09±3.95 min and 12.45±0.93 times,which were significantly higher than those in the non-bone cement group 57.00±4.24 min and 8.50±0.97 times,the difference was statistically significant(P<0.05).All patients'fractures healed in one stage,the healing time was 97.09±7.15 d in the cemented group and 103.00±13.14 d in the uncemented group,the difference was not statistically significant(t=1.297,P=0.210),and there was no case of delayed healing or non-healing.The postoperative weight-bearing time of the bone cement group was 44.73±3.72 d,which was shorter than that of the non-bone cement group 59.10±7.37 d,and the difference was statistically significant(P<0.05).The VAS sco

关 键 词：老年人 骨盆 骨质疏松性骨折 打印 三维 最小侵入性外科手术 

分 类 号：R687.3[医药卫生—骨科学]