3D打印技术在髋臼后壁骨折手术治疗中的应用

Application of 3D printing technology in treatment of acetabular posterior wall fractures

目的初步探讨3D打印技术在髋臼后壁骨折手术治疗中的应用效果。方法回顾性分析2014年1月至2015年4月收治的34例髋臼后壁骨折患者资料，男18例，女16例；年龄为21～65岁；骨折按Letournel．Judet分型：后壁骨折17例，后柱伴后壁骨折11例，横形伴后壁骨折6例。根据术前术中是否应用3D打印技术分为2组：3D技术组15例，男7例，女8例；平均年龄为（45．1±14．2）岁；常规组19例，男11例，女8例；平均年龄为（43．7±13．2）岁。3D技术组患者术前应用3D快速成型打印个体化骨折模型进行预手术，制定手术方案。所有患者均采用Kocher．Langenbeck入路AO微型联合重建接骨板内固定治疗。比较两组患者的手术时间、术中出血量、术中透视次数、骨折复位质量、末次随访时髋关节功能及术后并发症发生率等。结果34例患者术后获3～16个月（平均11．1个月）随访。3D技术组患者的手术时间【（83．2±13．5）min】较常规组患者[（96．8±13．1）min】短、术中出血量【（257．3±54．7）mL】和术中透视次数【（2．7±0．8）次】较常规组患者【（327．1±70．4）mL、（3．3±0．9）次】少，差异均有统计学意义（P〈0，05）。3D技术组和常规组患者术后骨折复位质量优良率分别为93．3％（14／15）、89．5％（17／19），末次随访时改良Merled’Aubign6和Postel评分平均分别为（16．2±1．6）、（16．0±1．5）分，术后并发症发生率分别为20．O％（3／15）、26．3％（5／19），差异均无统计学意义（P〉0．05）。结论3D打印技术可减少髋臼后壁骨折患者的手术时间、术中出血量及术中透视次数，是一种治疗髋臼后壁骨折的有效辅助手段。

Objective To evaluate the preliminary application of 3D printing technology in the treatment of acetabular posterior wall fractures. Methods A retrospective study was conducted to analyze the 34 patients who had been admitted for acetabular posterior wall fracture between January 2014 to April 2015. They were 18 men and 16 women, from 21 to 65 years of age. According to the Letournel-Judet classification, there were 17 cases of posterior wall fracture, 11 ones of posterior column ＋ posterior wall fracture, and 6 ones of transverse ＋ posterior wall fracture. Of them, 15 used 3D printing technology to fabricate individualized 3D fracture models for preoperative planning, including 7 men and 8 women, with an average age of 45. 1 ± 14. 2 years. The other 19 cases underwent conventional surgery without aid by 3D printing technology, including 11 men and 8 women, with an average age of 43.7 ± 13.2 years. All the pa- tients were treated by internal fixation through the Kocher-Langenbeck approach with AO mini plate combined with reconstruction plate. The 2 groups were compared in terms of operation time, intraoperative bleeding, intraoperative fluoroscopy frequency, fracture reduction, hip joint function at the last follow-up and postoperative complications.Results All the patients were followed up for an average of 11.1 months（range,from 3 to 16 months）.The operation time for the 3D group（83.2±13.5min）was significantly shorter than that for the conventional group（96.8±13.1min）,the intraoperative bleeding（257.3±54.7mL） and the intraoperative fluorosoopy frequency（2.7±0.8times）in the 3D group were significantly less than those in the conventional group（327.1±70.4mL;3.3±0.9times）（P〈0.05）.There were no significant differences between the 3D and conventional groups in the good to excellent rate of reduction[93.3%（14/15）versus 89.5%（17/19）],the modified Merle d＇Aubigne-Postel scores at the last follow-up（16.2±1.6versus 16.0±1.5）,or incidence of complications[20.0%（3/15）veraus 26.3%（5/19）]（P〉0.05）.Conclusion Inthe treatment of acetabular posterion wall fractures,3D printing is an effective adjuvant technique which can reduce operation time,intraoperativ blood loss,and intraoperative fluoroscopy frequency.