3D打印结合Union Plate跨弓状缘髋臼解剖钢板在复杂髋臼骨折中的应用

目的探讨术前在3D打印模型上规划后柱螺钉用于髋臼骨折内固定的可行性和安全性,评价这种联合技术对复杂髋臼骨折治疗的早期临床结果。方法回顾性分析华中科技大学同济医学院附属协和医院自2018年6月至2019年8月行复杂髋臼骨折的15例患者资料,根据CT数据行骨盆3D打印,得到1∶1(含髂血管)仿真模型,术前在三维模型上模拟手术固定,并规划后柱拉力螺钉,将螺钉消毒以备术中使用。术中采用高位髂腹股沟入路,并使用Union Plate跨弓状缘髋臼解剖钢板+后柱拉力螺钉进行固定。结果全部患者的手术均按照术前计划顺利进行,平均手术时间172 min(150~290 min),术中平均出血量620 m L(200~1 500 mL);所有后柱螺钉均成功置入,术中透视螺钉位置、长度良好。术后根据Matta标准评价骨折复位情况。其中优9例,良6例,优良率100%。按照Matta改良的Merle d'Aubigne和Postel评分评价髋关节功能,其中优8例,良5例,可2例,优良率为86.7%。围术期出现闭孔神经麻痹1例,随访3个月好转;未观察到切口感染、血栓形成、螺钉松动或断裂等并发症。结论通过术前3D打印模拟手术、规划后柱拉力螺钉,结合跨弓状缘髋臼解剖钢板治疗复杂髋臼骨折置钉成功率高,安全性好,个体化强,效果可靠。

Combination of 3D printing and the supra-pectineal quadrilateral surface buttress plate for the treatment of complex acetabular fractures

Objective To investigate the feasibility and safety of planning posterior column screws on 3 D printing model for internal fixation of acetabular fractures,and evaluate the early clinical results of this combined technique in the treatment of complex acetabular fractures.Methods The data of 15 patients with complex acetabular fractures in Union Hospital,Tongji Medical College,Huazhong University of Science and Technology from June 2018 to August 2019 were retrospectively analyzed.According to the CT data,pelvis 3 D printing was performed to obtain a 1:1(including iliac vessels)simulation model.Preoperative surgical fixation was simulated on the three-dimensional model,and the lag screw of posterior column was planned to sterilize the screws for use during operation.The supra-ilioinguinal approach was used,and the supra-pectineal quadrilateral surface buttress plate and posterior column lag screw were used for fixation.Results The operation of all patients was carried out smoothly according to the preoperative plan,the average operation time was 172 min(150-290 min),the average intraoperative blood loss was 620 mL(200-1500 mL);all the posterior column screws were successfully inserted,and the position and length of fluoroscopic screws were good.The fracture reduction was evaluated according to Matta criteria.Among them,9 cases were excellent and 6 cases were good,the excellent and good rate was 100%.According to Matta modified Merle d’Aubigne and Postel score,8 cases were excellent,5 cases were good and 2 cases were fair,the excellent and good rate was 86.7%.One patient had obturator nerve palsy during the perioperative period,which was improved after 3 months of follow-up.Conclusion Through preoperative 3 D printing simulation surgery,planning posterior column lag screw,combined with the supra-pectineal quadrilateral surface buttress plate in the treatment of complex acetabular fractures,good clinical effect has been achieved.The success rate of screw placement is high,the safety is good,the individualization is strong.