3D打印辅助小切口复位内固定治疗跟骨骨折

Clinical Efficacy of 3D-printing Assisting Minimally Invasive Fixation in the Treatment of Calcaneal Fractures

目的观察3D打印辅助小切口复位内固定治疗跟骨骨折的临床疗效。方法选取2014年10月-2015年5月收治的12例闭合跟骨关节内移位患者。术前打印1︰1大小的健侧和患侧3D打印模型,便于其详细了解骨折情况、模拟骨折复位及进行钢板预塑形,采用外侧小切口入路,了解手术时间、复位情况、术后并发症的发生及术后功能,功能评价采用美国足踝外科学会的踝-后足评分(AOFAS评分),复位情况根据Bohler角、Gissane角评价。结果 12例术后患者均无切口感染或切口不愈合的并发症,术后随访骨折愈合良好。术后Bohler角(29.4±6.1)°、术后Gissane角(121.4±12.6)°,术前术后Bohler角、跟骨Gissane角差异有统计学意义(P<0.01)。术后AOFAS评分(75.2±5.4)分,优良率达83.3%。结论 3D打印辅助小切口治疗跟骨骨折,术前可模拟骨折复位、钢板预塑形,有利于骨折复位,并简化术中操作。

Objective To analyze the clinical outcomes of 3D-printing assisting minimally invasive fixation of calcaneal fractures. Methods The study included 12 patients who were diagnosed with calcaneal fractures between October 2014 and May 2015. Using a real-size 3D-printed calcaneus model, the calcaneal locking plate could be pre- shaped before the operation and used with a minimally invasive approach to achieve rigid plate fixation just as with the lateral approach. Complications and surgery time were recorded and functional results were evaluated using the American Orthopaedic Foot Society ankle-metapedes score （AOFAS）. The reduction of fracture was evaluated using the Bohler angle and Gissane angle. Results There was no relevant postoperative complications. All fractures got bone union. The mean postoperative Bohler angle was （29.4±6.1）° and the mean postoperative Gissane angle was （121.4±12.6）°. The difference in Bohler angle and calcaneal Gissane angle before and after the surgery was significant （P 〈 0.01）. The mean postoperative AOFAS score was 75.2±5.4, and the fine/excellent rate was 83.3%. Condusion We believe this novel technique can be useful for the operative treatment of displaced intra-articular calcaneal fractures.