3D打印技术联合组合式接骨板内固定治疗陈旧性髋臼后壁骨折

目的:探讨3D打印技术联合组合式接骨板内固定在治疗陈旧性髋臼后壁骨折中的应用价值及临床疗效。方法:自2010年5月至2016年10月,采用Mimics19.0软件,按1∶1打印骨盆3D模型进行术前规划,同时应用组合式接骨板内固定治疗23例陈旧性髋臼后壁骨折患者,男15例,女8例;年龄20～63(43.0±5.1)岁;受伤至手术时间23～101(47.0±10.5) d。骨折按Letournel-Judet分型:后壁骨折11例,横行伴后壁骨折7例,后柱伴后壁骨折5例;所有患者采用单一Kocher-Langenbeck入路行组合式接骨板内固定,记录术中、术后及随访时观察评定指标。结果:23例患者手术时间(113.5±11.5) min,术中出血(550.0±104.7) ml,术中透视(12.7±0.8) s。采用Matta放射学复位评定标准:优14例,良7例,差2例;23例患者均获得10～24(16.0±5.6)个月随访,末次随访根据改良Merle d’Aubingne和Postel评分系统评定髋关节功能:优11例,良8例,可3例,差1例。术后发生创伤性关节炎3例,股骨头坏死1例,异位骨化2例,坐骨神经刺激征5例。结论:3D打印技术进行术前模拟联合组合式接骨板坚强固定,是一种有效、快捷治疗陈旧性髋臼后壁骨折的手术方法。此外,打印模型能够为术者提供三维立体形态结构,结合术前模拟,便于术中复位,有效提高了手术效率。

Treatment of old acetabular posterior wall fracture with 3D printing combined with composite plate internal fixation

Objective:To explore the application value and clinical effect of three-dimensional printing combined with composite plate internal fixation in the treatment of old acetabular posterior wall fracture.Methods:From May 2010 to October 2016,Mimics 19.0 software was used to plan preoperatively according to a 1:1 print pelvic 3D model. At the same time,23 patients with old acetabular posterior wall fractures were treated with combined plate internal fixation,including 15 males and 8 females,aged 20 to 63 (43.0±5.1) years old,and the time from injury to operation was 23 to 101(47.0±10.5) days. According to Letournel-Judet classification,11 cases were posterior wall fracture,7 cases were transverse with posterior wall fracture,and 5 cases were posterior column with posterior wall fracture. All patients were treated with single Kocher-Langenbeck approach combined plate internal fixation,and the evaluation indexes were recorded during operation,after operation and during follow-up.Results:The operation time of 23 patients was (113.5±11.5) min,bleeding was (550.0±104.7) ml and fluoroscopy was (12.7±0.8) s. Matta radiographic reduction criteria were used:excellent in 14 cases,good in 7 cases and poor in 2 cases; 23 patients were followed up for 10 to 24 (16.0±5.6) months. The hip function was evaluated according to the modified Merle d''Aubingne and Postal scoring system at the last follow-up:excellent in 11 cases,good in 8 cases,fair in 3 cases and poor in 1 case. There were 3 cases of traumatic arthritis,1 case of femoral head necrosis,2 cases of heterotopic ossification and 5 cases of sciatic nerve irritation.Conclusion:3D printing technique is an effective and fast method for the treatment of old acetabular posterior wall fractures. In addition,the printing model can provide three-dimensional morphological structure for the operator,combined with preoperative simulation,facilitate intraoperative reduction,and effectively improve the efficiency of surgery.