3D打印技术结合腹直肌外侧入路治疗累及四边体的髋臼骨折

目的 探讨3D打印技术结合腹直肌外侧入路治疗累及四边体的髋臼骨折的疗效。方法 回顾性分析肇庆市第一人民医院2014年9月至2018年8月期间收治的22例累及四边体的髋臼骨折患者资料。其中，男16例，女6例；年龄为17 ～ 68岁，平均42.6岁；根据Letournel-Judet分型：前柱骨折4例，前柱＋后半横断骨折8例，双柱骨折5例，横断骨折3例，“T”形骨折2例。术前将骨盆CT数据导入Mimics软件进行三维重建并模拟复位，打印出髋臼实体模型进行手术演练，术中经腹直肌外侧入路直视下复位骨折，用预塑形好的重建板固定髋臼四边体，空心钉固定髋臼后柱骨折，术后复查CT片，记录髋臼骨折复位质量、髋关节功能及并发症发生情况。结果 22例患者随访18 ～ 41个月，平均28.5个月。骨折复位按照Matta标准评价，其中优15例，良5例，可2例，优良率90.9%（20/22）。末次随访时，髋关节功能按照Matta改良的Merle d''Aubigne和Postel评分为13 ～ 18分，平均16.3分，其中优13例，良6例，可3例，优良率为86.4%（19/22）。出现切口脂肪液化1例、下肢深静脉血栓1例，并发症发生率为9.1%（2/22）。结论 腹直肌外侧入路解剖清晰，显露充分，创伤小，可以直视下复位和固定累及四边体的髋臼骨折，而结合3D打印技术辅助治疗该类型骨折，可缩短手术时间和减少出血量，降低并发症的发生率，使手术更加精准微创，并获得满意的治疗效果。

The lateral-rectus approach combined with 3D printing technology for the treatment of acetabular fractures involving quadrilateral surface

Objective To explore the efficacy of lateral-rectus approach combined with 3D printing technology for the treatment of acetabular fractures involving quadrilateral surface. Methods A total of 22 patients with acetabular fractures involving quadrilateral surface were admitted to the First People''s Hospital of Zhaoqing from September 2014 to August 2018. There were 16 males and 6 females, with an average age of 42.6 years (from 17 to 68 years). According to the Letournel-Judet classification, there were 4 anterior column fractures, 8 anterior and posterior hemi-transverse fractures, 5 both-column fractures, 3 transverse fractures, and 2 T-shaped fractures. For all cases a preoperative surgical simulation was implemented based on their 3D-printed acetabular models. A pre-bent reconstruction plate was placed to fixate the fracture after reduction via the lateral-rectus approach,and the posterior column was fixed with hollow screw. The reduction quality,function of affected hip and complications were recorded. Results The 22 patients were followed up for an average time of 28.5 months (range, 18-41 months). According to the Matta standard evaluation, the postoperative reduction was rated as excellent in 15 cases, good in 5 cases,and fair in 2 cases. The excellent/good rate was 90.9%(20/22). According to the modified Merle d''Aubigne-Postel scoring at the final follow-up, the average score of affected hip function was 16.3(range score 13-18).Among them,13 cases were categorized as excellent,6 cases as good, and 3 cases as fair. The excellent and good rate was 86.4%(19/22). Complications included deep venous thrombosis in 1 case and fatty fluidization in 1 case, and the incidence of complication was 9.1%(2/22). Conclusion Surgical management through the lateral-rectus approach can provide clear anatomy, adequate exposure, and small trauma. Acetabular fractures involving quadrilateral surface can be reducted and fixed directly, and 3D printing technology combined treatment for this type of fracture, can reduce the operation time and intraoperative blood loss, reduce the incidence of complications, provide accurate minimally invasive surgery, and obtain satisfactory therapeutic effect.