3D 打印结合微创钢板内固定技术在胫骨远端骨折中的临床应用

目的 探讨3D 打印结合微创钢板内固定技术治疗胫骨远端骨折的临床疗效。方法 选取2017 年1 月—2017 年10 月于武汉科技大学附属普仁医院骨科确诊的闭合性胫骨远端骨折患者24 例，按照随机数字表法将其分为3D 微创组和常规微创组；患者均行胫腓骨下段CT 扫描。3D 微创组数据以医学数字成像及通信格式输出，数据经Mimics 软件处理后输入3D 打印机，制作出与骨折部位比例1 ∶ 1 的骨折模型，术前模拟复位，制定个性化手术方案；常规微创组按常规MIPPO 技术行骨折内固定术。比较两组患者手术时间、术中出血量、术中透视次数；采用Burwell-Charnley 标准评价骨折复位情况；采用AOFAS 踝关节评分系统评价患者术后12 个月踝关节功能恢复情况。结果 两组Burwell-Charnley 影像学评价比较，差异无统计学意义（P >0.05）；3D 微创组手术时间、术中出血量和术中透视次数少于常规微创组（P <0.05）；两组术后踝关节AOFAS 评分比较，差异无统计学意义（P >0.05）。结论 应用3D 打印结合微创钢板内固定技术治疗胫骨远端骨折较传统微创手术具有明显优势，可以为胫骨远端骨折治疗提供新的思路。

Clinical application of 3D printing combined with minimallyinvasive plate internal fixation in distal tibial fractures

Objective To investigate the clinical effect of 3D printing combined with minimally invasiveplate in the treatment of distal tibial fractures. Objective From January 2017 to October 2017, 24 patients withclosed distal tibial fractures were diagnosed in the Department of Orthopaedics, Puren Hospital affiliated to WuhanUniversity of Science and Technology. They were randomly divided into 3D minimally invasive group (n = 12) andconventional minimally invasive group (n = 12) according to the number table method, and all patients underwent CTscan of the lower tibia and fibula. The data of 3D minimally invasive group were output in medical digital imagingand communication (Digital Imaging and Communications in Medicine, DICOM) format. The data were processedby software and input into 3D printer to make a fracture model with a ratio of 1:1 to fracture site and simulatedreduction before operation. According to the routine MIPPO technique, the fracture internal fixation was performedin the conventional minimally invasive group. The operation time, intraoperative blood loss and intraoperative fluoroscopy were compared between the two groups; Burwell-Charnley standard was used to evaluate the reduction of fracture; AOFAS ankle score system was used to evaluate the functional recovery of ankle joint 12 months after operation. Results There was no significant difference in imaging scores between the two groups (P > 0.05); the operation time, blood loss and the number of fluoroscopy in 3D minimally invasive group were significantly better than those in conventional minimally invasive group (P < 0.05); the AOFAS ankle score of 3D minimally invasive group was compared with that of conventional minimally invasive group at 12 months after operation. There was no significant difference (P > 0.05). Conclusion The application of 3D printing combined with minimally invasive plate technique in the treatment of distal tibial fractures has obvious advantages over traditional minimally invasive surgery, and can provide a new idea for the treatment of distal tibial fractures.