3D打印技术辅助治疗与传统手术方法治疗复杂胫骨平台骨折的对比研究

目的比较应用3D打印技术辅助手术与传统手术治疗复杂胫骨平台骨折的临床疗效。方法回顾性分析解放军武汉总医院骨科2013年12月—2016年9月治疗51例复杂胫骨平台骨折患者的临床资料,其中Schatzker V型骨折33例,Ⅵ型18例。根据术前是否行3D打印骨折模型分为3D打印辅助手术组和传统手术组。3D打印辅助手术组19例,男性12例,女性7例;年龄21~65岁,平均44.7岁。传统手术组32例,男性19例,女性13例;年龄19~62岁,平均47.1岁。记录对比两组手术时间、术中出血量、术中透视次数及术后6个月膝关节Rasmussen评分和HSS膝关节功能评分(hospital for special surgery knee score,HSS)。结果术后51例患者均获得随访,3D打印辅助手术组平均手术时间(97.7±13.7)min,平均术中出血量(207.4±41.7)m L,术中透视次数(4.6±1.5)次;术后6个月影像学Rasmussen评分(16.8±1.8)分,HSS评分(90.1±5.9)分。传统手术组平均手术时间(110.5±17.7)min,平均术中出血量(291.1±5.2)m L,术中透视次数(6.4±1.7)次;术后6个月Rasmussen评分(16.5±2.6)分,HSS评分(88.3±6.3)分。3D打印辅助手术组手术时间、术中出血量与传统手术组相比,差异有统计学意义(P0.05);术后6个月Rasmussen及HSS评分差异无统计学意义(P0.05)。结论与传统手术相比,3D打印技术辅助手术治疗复杂胫骨平台骨折,可以明显减少手术时间,减少术中出血量及透视次数,但对术后6个月时的膝关节功能恢复未能明显改善。

Comparison of the clinical efficacy of 3D printing and traditional surgical methods in the treatment of complex tibial plateau fractures

Objective To compare the clinical efficacy of traditional surgery and surgery assisted by 3D printing technology in the treatment of complex tibial plateau fractures.Methods A retrospective analysis was per-formed on 51 cases of complex tibial plateau fractures at Department of Orthopedics of Wuhan General Hospital of PLA from Dec.2013 to Sep.2016.According to the Schazker classification,33 cases were typeⅤand 18 cases wereⅥ.These patients were divided into two groups as 3D printing assisted operation group and traditional operation group,according to whether 3D printing technology was applied.The 3D printing assisted operation group included 12 males and 7 females(aging from 21 to 65 years,mean age 44.7),and the traditional operation group included 19 males and 13 females(aging from 19 to 62 years,mean age 47.1).Operation time,blood loss,and times of intra-op-erative fluoroscopy were recorded.Through the follow-up,the recovery of patients was observed by Rasmussen score and the HSS knee function score.Results All the patients were followed up for 11 to 22 months.The average op-eration time,average amount of blood loss,and the times of intra-operative fluoroscopy for 3D model group was (97.7 ±13.7)minutes,(207.4 ±41.7)mL,(4.6 ±1.5)times,and for traditional surgery group was(110.5 ± 17.7)minutes,(291.1 ±5.2)mL,(6.4 ±1.7)times,respectively.There was statistically significant difference between the traditional surgery group and 3D model group(P<0.05),but the difference in 6-month post-operation Rasmussen score and HSS score had no statistical significance.Conclusion Compared with traditional surgery,3D printing technology assisted operation for complex tibial plateau fractures can significantly reduce operative time,re-duce operative bleeding and fluoroscopy times,but fail to improve knee joint function at 6 months after operation.