3D打印结合虚拟手术设计治疗复杂Pilon骨折

文题释义：Pilon骨折：为发生于胫骨远端1/3波及胫骨远端关节面的粉碎性或压缩骨折，治疗关键在于有效复位骨折、恢复踝关节面正常解剖关系。目前临床上主要包括切开复位内固定、外固定术等治疗术式。 3D打印结合虚拟手术设计：是以3D打印技术与虚拟手术设计相结合，全面、直观、准确地显示骨折的立体形态和各部位解剖结构的空间关系。通过3D Objects窗口中的Move和Rotate对骨折块进行虚拟移动并复位，根据虚拟操作情况，制定虚拟骨折块复位方式、移动距离及旋转角度，可以缩短手术时间、减少手术创伤及出血量、获得更好的骨折复位及功能恢复的一种方法。 背景：Pilon骨折主要是垂直压缩暴力累及胫骨远端关节面的骨折，尤其是高能量损伤的Pilon骨折，其骨折移位明显，干骺端不同程度的压缩、粉碎，高度不稳定、关节软骨原发性损伤以及关节面不平整是Pilion骨折的特征，因其治疗难度大、并发症多、致残率高，已成为骨科最具挑战性的难题之一。良好的术前规划与设计可减少并发症的发生，获得更好的修复效果。 目的：探讨3D打印技术结合虚拟手术设计在复杂Pilon骨折治疗中的应用效果。 方法：选择2017年8月至2018年11月玉林市中西医结合骨科医院收治的88例复杂Pilon骨折患者，按随机数字表法分为2组，3D打印组38例，对照组50例。3D打印组采用3D技术结合虚拟手术设计辅助进行手术治疗，对照组采用传统常规手术。记录2组手术时间、手术出血量、手术切口长度、钢板一次性成功放置率、术后踝关节功能恢复情况及术口愈合情况。 结果与结论：①3D打印组在手术时间、手术出血量、手术切口长度、钢板一次性成功放置率、复位满意度(Burwell-Charnley骨折复位放射学评价)、术后12个月随访功能恢复程度(Mazur踝关节评分)、术口愈合情况方面均优于对照组，差异均有显著性意义(P < 0.05)；②提示与传统常规手术相比，使用3D打印结合虚拟手术设计治疗复杂Pilon骨折可以缩短手术时间、减少手术创伤及出血量，获得更好的骨折复位及功能恢复。 ORCID: 0000-0002-7553-7254(梁周) 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Three-dimensional printing combined with virtual surgical design in the treatment of complex Pilon fractures

BACKGROUND:Pilon fractures are mainly vertical compression violence involving the tibia distal articular surface fracture,especially the high-energy damage Pilon fracture.Pilion fracture is characterized by obvious fracture displacement,different levels of compression,crushing at stem epiphyseal end,unstable height,primary articular cartilage injury and uneven joint surface.Because it is difficult to treat,and holds various complications and high morbidity,it becomes a challenge in the field of orthopedics.Good preoperative planning and design can reduce the occurrence of complications and obtain good clinical treatment outcomes.OBJECTIVE:To explore the clinical effect of three-dimensional printing technology combined with virtual surgery design in the treatment of complex Pilon fractures.METHODS:Eighty-eight patients with complex Pilon fracture at Yulin Orthopedics Hospital of Chinese and Western Medicine from August 2017 to November 2018 were selected and divided into two groups(three-dimensional printing group,n=38;control group,n=50).The three-dimensional printing group was treated with three-dimensional printing technology combined with virtual surgery design,and the control group was treated with conventional surgery.The operation time,blood loss,incision length,one-time successful placement rate,postoperative ankle function recovery and healing were recorded.RESULTS AND CONCLUSION:(1)The three-dimensional printing group was superior to the control group in terms of operation time,blood loss,incision length,one-time successful placement rate,reduction satisfaction(Burwell-Charnley fracture reduction radiology evaluation),functional recovery degree(Mazur ankle joint score)after 12-month follow-up and wound healing(P<0.05).(2)To conclude,compared with conventional surgery,three-dimensional printing combined with virtual surgery design for treating complex Pilon fractures can shorten the operation time,reduce surgical trauma and blood loss,and achieve satisfactory fracture reduction and functional recovery.