数字化设计结合3D打印技术辅助手术治疗复杂型胫骨平台骨折

目的　探讨数字化设计结合3D打印技术辅助手术治疗复杂型胫骨平台骨折的临床疗效。方法　回顾性分析自2013年10月-2015年9月本院收治的40例胫骨平台粉碎性骨折患者资料，其中男27例，女13例；按Schatzker骨折分型，Ⅳ型19例，V型15例，Ⅵ型6例。其中20例患者（3D打印组）应用3D打印技术辅助手术：术前进行三维重建骨折模型、骨折块虚拟复位、挑选最匹配的钢板、3D打印1:1大小的骨折模型、模拟骨折复位及钢板塑形；20例患者（传统手术组）为传统切开复位内固定治疗。记录两组的手术时间、术中出血量、切口长度及膝关节功能评分。 结果　40例患者均顺利完成手术，3D打印组患者的手术时间、术中出血量、切口长度均显著小于对照组(P <0.01), 术后随访8~13个月（平均10个月），两组病例均获得骨性愈合，3D打印组术后膝关节功能Rasmussen评分显著高于对照组(P <0.01)。 结论　数字化设计结合3D打印技术辅助手术治疗复杂型胫骨平台骨折，实现了复杂型胫骨平台骨折的个体化、精准化治疗，可缩短手术时间，减少术中出血量，有效缩短患者的康复周期。

Operation for complicated tibial plateau fractures with digital design and three-dimensional printing technique

Objective　To explore the effectiveness of internal fixations for complicated tibial plateau fractures using digital design and three-dimensional printing technique. 　Methods　A retrospective analysis was performed on 40 cases of complicated tibial plateau fractures at our department from October 2013 to September 2015．There were 27 male and 13 female patients．According to the Schatzker classification, there were 19 cases of typeⅣ，15 cases typeⅤ，and 6 cases typeⅥ．Among them, 20 patients (3D group)underwent 3D printing assisted operations for the following procedure: first construct 3D models, followed by virtual fractures reductions for choice of the most appropriate plates and printing of real-size 3D models; Afterwards, the fractures reduction was simulated with prebent plates, and 20 patients (control group) underwent conventional open reduction and internal fixation operations. The operation time, intraoperative bleeding, and incision length in 3D group, and knee functional scores were compared between the two group．Results　All 40 patients were significantly less than those in the control group (P<0.01). Allpatients achieved bony union after follow-up 8~13 months (mean, 10 months). The Rasmussen scores in 3D group were higher than those in the control group (P<0.01).　Conclusion　By using digital design software and three-dimensional (3D) printing technique, we can achieve individualized operation and precise treatment, which can lead to less blood loss and shorter hospital stay.