3D打印结合定制钢板内固定技术在治疗复杂胫骨干骨折中的应用

目的研究3D打印结合定制钢板技术治疗复杂的胫骨干骨折的临床疗效。方法运用回顾性研究对2014年1月至2014年6月收集的23例进行治疗的新鲜闭合性胫骨C型骨折病例进行分析,其中11例采用3D打印结合定制钢板内固定技术治疗的3D组以及12例采用传统胫骨钢板固定治疗的传统组。3D组的年龄为(42.6±12.3)岁,受伤至手术时间为(4.9±1.0)d;传统组的年龄为(41.2±11.0)岁,受伤至手术时间为(4.4±1.0)d。3D组在术前打印出患者损伤胫骨的真实3D模型,并根据患者个体情况制作个性化定制钢板用于术中使用;传统组则采用普通术前准备,术中使用传统胫骨钢板固定。比较两组的术中出血量、手术时间、术中透视次数、骨折愈合时间、Matta骨折复位标准、Johner-wruhs评分。结果3D组的随访时间为(19.9±4.3)个月,传统组的随访时间为(18.4±4.0)个月。3D组的手术时间为(117.27±25.82)min、术中出血量为(118.18±40.45)mL、透视次数为(4.09±1.14)次、骨折愈合时间为(13.18±1.72)周。传统组的手术时间为(142.50±30.34)min、术中出血量为(170.83±68.95)mL、透视次数为(6.17±2.08)次、骨折愈合时间为(15.41±3.08)周。两组间比较差异均有统计学意义(P<0.05)。结论3D打印结合定制钢板内固定技术治疗胫骨骨折可减少术中出血与透视次数,减少手术时间,减少手术创伤与手术风险,方便医患交流,改善患者预后。

Application of three-dimensional printing combined with individualized customized plate in internal fixation of the complicated tibial shaft fractures

Objective To explore the clinical efficacy of the internal fixation of the complicated tibial shaft fractures by three-dimensional printing combined with individualized customized plate. Methods Retrospective cohort study was used to analyze the twenty-three patients treated in our department from January 2014 to June 2014 because of fresh closed tibiofibula fractures. The whole patients were separated into 3 D group(11 cases) and traditional group(12 cases)depend on the treatment them got. The age of the 3 D group was(42.6±12.3) years old and the time from injury to surgery was(4.9±1.0) d;the age of the traditional group was(41.2±11.0) years old and the time from injury to surgery was(4.4±1.0) d,respectively. The content was compared contain the amount of blood loss, duration of surgery, fluoroscopy frequency, healing time of fracture, Matta criteria and Johner-wruhs score of the two groups. Results Followup time of 3 D group and traditional group was(19.9±4.3) months and(18.4±4.0) months, respectively. The operation time of the 3 D group was(117.27±25.82) min, the intraoperative blood loss was(118.18±40.45) m L, the number of fluoroscopy was(4.09±1.14) times, and the fracture healing time was(13.18±1.72) weeks. The operation time of the traditional group was(142.50±30.34) min, intraoperative blood loss(170.83±68.95) mL, fluoroscopy(6.17±2.08) times, fracture healing time(15.41±3.08) weeks. There were significant differences between the two groups(P<0.05). Conclusion Three-dimensional printing combined with individualized customized plate fixation technique shorten the duration of operation time, reducing the risk of operation and improve the outcomes of the patients with complicated tibiofibula fractures than traditional treatment.