3D打印辅助微创经皮钢板接骨与髓内钉治疗AO12-C型肱骨中上段骨折的比较  

3D printing assisted minimal invasive plate osteosynthesis versus intramedullary nail for treatment of AO12-C middle-proximal humeral fractures

作　　者：胡超然 岑超德 杨洋[1] 周城 黄华先 袁虹豪 罗琴 曹永飞 Hu Chaoran;Cen Chaode;Yang Yang;Zhou Cheng;Huang Huaxian;Yuan Honghao;Luo Qin;Cao Yongfei(Department of Orthopedics,Guizhou Hospital of Beijing Jishuitan Hospital,Guiyang 550014,Guizhou Province,China)

机构地区：[1]北京积水潭医院贵州医院创伤骨科,贵州省贵阳市550014

出　　处：《中国组织工程研究》2025年第33期7116-7122,共7页Chinese Journal of Tissue Engineering Research

基　　金：2022年贵州省卫生健康委员会科学技术基金项目(gzwkj2022-364),项目负责人:胡超然。

摘　　要：背景:AO12-C型肱骨中上段骨折通常由高能量损伤引起,骨折粉碎,伴有较多的蝶形骨块,难以获得良好复位和有效固定;随着对骨与软组织生物学特征的认识逐渐提高,目前手术治疗也逐渐向微创钢板和髓内钉内固定等方式转变,但对于微创经皮钢板接骨和髓内钉哪项是治疗肱骨骨折的最佳技术迄今尚未达成共识。目的:比较3D打印辅助微创经皮钢板接骨与髓内钉治疗AO12-C型肱骨中上段骨折的疗效。方法:回顾性分析2020年1月至2022年12月北京积水潭医院贵州医院收治的符合纳入标准的36例AO12-C型肱骨中上段骨折患者,根据手术方式将患者分为微创钢板组和髓内钉组,每组18例。微创钢板组在3D打印辅助进行术前规划的基础上进行微创钢板接骨治疗;髓内钉组进行髓内钉内固定治疗。比较两组患者手术时间、术中出血量、住院时间及骨折愈合时间;对比两组术后1,3,6个月的疼痛目测类比评分、末次随访时肩关节功能、Constant-Murley评分、快速肩臂手功能障碍评分以及并发症等指标情况。结果与结论:①所有患者平均随访(15.56±4.05)个月,两组患者住院时间和骨折愈合时间相比差异无显著性意义(P>0.05),微创钢板组手术时间更短(P<0.05),髓内钉组术中出血更少(P<0.05);②术后1,3个月时髓内钉组目测类比评分低于微创钢板组(P<0.05),但在长期随访时两组患者目测类比评分、末次随访时Constant-Murley评分、快速肩臂手功能障碍评分及肩关节功能均无显著差异(P>0.05);③两组患者均未出现骨不连及伤口感染等并发症,微创钢板组患者术后出现2例桡神经麻痹,均在术后3个月内恢复,而髓内钉组出现1例肩袖损伤;两组患者的术后并发症发生率无显著差异(P>0.05);④提示微创经皮钢板接骨技术及髓内钉治疗AO12-C型肱骨中上段骨折均可获得良好的临床疗效,能够有效改善患者的肩关节功能,但微�BACKGROUND:The AO12-C type middle-proximal humeral fractures are usually caused by high-energy injuries,accompanied by comminuted fractures and a large number of butterfly-shaped bone fragments.These fractures are difficult to achieve good reduction and effective fixation.With the increasing understanding of the biological characteristics of bone and soft tissue,surgical treatment is gradually shifting towards minimally invasive steel plates and intramedullary nail fixation.However,there has been no consensus on which is the best surgical technique for treating humeral fractures in minimal invasive plate osteosynthesis and intramedullary nail.OBJECTIVE:To compare the clinical effect of minimal invasive plate osteosynthesis and intramedullary nail for treating AO12-C type middle-proximal humeral fractures.METHODS:A retrospective analysis was performed in 36 patients with AO12-C type middle-proximal humeral fracture who met the inclusion criteria admitted to the Guizhou Hospital of Beijing Jishuitan Hospital from January 2020 to December 2022.All patients were assigned to minimal invasive plate osteosynthesis group(18 cases)and intramedullary nail group(18 cases)according to the surgical treatment plan.The minimal invasive plate osteosynthesis group received minimally invasive plate osteosynthesis based on preoperative planning assisted by 3D printing,while the intramedullary nail group received intramedullary nail internal fixation.Operation time,intraoperative blood loss,hospital stay,and fracture healing time were compared between the two groups.Visual analog scale score at 1,3,and 6 months after surgery,shoulder joint function,Constant-Murley score,Quick Disabilities of the Arm,Shoulder and Hand(QuickDASH)score,and complications of the shoulder joint at the last follow-up were compared between the two groups.RESULTS AND CONCLUSION:(1)All patients were followed-up for average(15.56±4.05)months,and no difference was observed in hospital stay and fracture healing time between the two groups(P>0.05).The minimal in

关 键 词：3D打印 肱骨中上段骨折 经皮微创接骨板 髓内钉 内固定 桡神经损伤 肩袖损伤 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R687.3