3D打印结合T型钢板弹性支撑固定治疗累及后柱的复杂髋臼骨折的效果评估

Evaluation of 3D printing combined with T-plate elastic support fixation in the treatment of complex acetabular fractures involving posterior columns

目的探讨3D打印结合T型钢板弹性支撑固定治疗累及后柱的复杂髋臼骨折的效果。方法2020年1月~2023年1月收治的累及后柱的复杂髋臼骨折病人84例,随机数字表法分为观察组和常规组,每组各42例。常规组行T型钢板弹性支撑固定,观察组在常规组的基础上给予3D打印。比较两组病人手术时间、骨折愈合时间、复位优良率、骨愈合相关因子血清骨形态发生蛋白2(BMP-2)水平、转化生长因子-β1(TGF-β1)水平、骨痂骨密度和术后并发症。结果观察组手术时间为(227.58±25.96)分钟、骨折愈合时间为(42.54±3.68)天,均低于常规组的(285.47±35.85)分钟、(56.98±6.74)天,差异有统计学意义(P<0.05),观察组术中出血量(458.25±48.14)ml,少于常规组的(526.35±58.52)ml,差异有统计学意义(P<0.05),术后30天,观察组与常规组的BMP-2分别为(86.98±10.36)ng/L,(82.39±9.20)ng/L,TGF-β1分别为(63.85±8.17)ng/ml,(55.85±7.12)ng/ml,与术前比较差异有统计学意义(P<0.05),观察组与常规组的BMP-2和TGF-β1水平均高于术前;观察组的BMP-2和TGF-β1水平高于常规组,差异有统计学意义(P<0.05),观察组骨折复位优良率(95.24%)高于常规组(80.95%),差异有统计学意义(P<0.05),观察组术后30天、术后3个月的骨痂骨密度分别为(0.44±0.07)g/cm^(2)、(0.59±0.10)g/cm^(2),均高于常规组的(0.32±0.04)g/cm^(2)、(0.42±0.09)g/cm^(2),差异有统计学意义(P<0.05)。常规组术后并发创伤性关节炎2例,1例异位骨化,总并发症发生率为7.14%;观察组并发创伤性关节炎2例,2例异位骨化,总并发症发生率为9.52%。两组总并发症发生率比较;差异无统计学意义(P>0.05)。结论3D打印结合T型钢板弹性支撑固定治疗累及后柱的复杂髋臼骨折可获取满意手术复位效果,促进骨折复位,提高骨痂骨密度,且安全可靠。

Objective To evaluate the efficacy of combining 3D printing with T-shaped steel plate elastic fixation in the treatment of complex acetabular fractures involving the posterior column.Methods A total of 84 patients with complex acetabular fractures involving the posterior column,admitted to the hospital from January 2020 to January 2023,were randomly divided into an observation group(42 cases)and a control group(42 cases)using a random number table.The control group underwent T-shaped steel plate elastic fixation,while the observation group received 3D printing in addition to the conventional treatment.The surgical outcomes,fracture healing time,and reduction quality were compared between the two groups.Additionally,serum bone morphogenetic protein-2(BMP-2),transforming growth factor-β1(TGF-β1),bone callus density,and postoperative complications were compared between the two groups.Results The operation time and fracture healing time of the observation group were(227.58±25.96)minutes and(42.54±3.68)days,which were lower than(285.47±35.85)minutes and(56.98±6.74)days of the conventional group,and the differences were statistically significant(P<0.05).The intraoperative blood loss of the observation group was(458.25±48.14)ml,which was less than the conventional group[(526.35±58.52)ml],and the difference was statistically significant(P<0.05).On the 30th day after surgery,BMP-2 of the observation group and the conventional group was(86.98±10.36)ng/L and(82.39±9.20)ng/L,respectively,TGF-β1was(63.85±8.17)ng/ml and(55.85±7.12)ng/ml,respectively.The levels of BMP-2 and TGF-β1 in the observation group and the conventional group were higher than those before operation(P<0.05),and the levels of BMP-2 and TGF-β1 in the observation group were higher than those in the conventional group(P<0.05).The excellent and good rate of fracture reduction in observation group(95.24%)was higher than that in conventional group(80.95%)(P<0.05).The bone callus density[(0.44±0.07)g/cm^(2) and(0.59±0.10)g/cm^(2)]in the observation group were higher than those in the conventional group[(0.32±0.04)g/cm^(2) and(0.42±0.09)g/cm^(2)]at 30 d and 3 months after surgery(P<0.05),and there were 2 cases of traumatic arthritis in the conventional group.One case of ectopic ossification,the total complication rate was 7.14%;In the observation group,there were 2 cases of traumatic arthritis and 2 cases of ectopic ossification.The total complication rate was 9.52%.There was no significant difference in the total complication rate between the two groups(P>0.05).Conclusion The combination of 3D printing and T-shaped steel plate elastic fixation in the treatment of complex acetabular fractures involving the posterior column can achieve satisfactory surgical reduction,promote fracture healing,improve bone callus density,and is safe and reliable.