3D打印导向模板辅助下耻骨上支外侧髓内拉力螺钉置钉的临床应用

Clinical application of personalized 3D printing-guided template of intramedullary lag screw insertion on lateral superior ramous of pubic

目的:评价3D打印导向模板辅助下耻骨上支外侧髓内拉力螺钉的临床疗效和优势。方法:2015年7月至2016年12月,符合纳入标准的耻骨上下支骨折患者20例,选择拉力螺钉固定手术方法,分为试验组和对照组,试验组导向模板辅助置钉,对照组常规手术置钉,试验组中男7例,女3例,年龄(46.20±3.03)岁,其中左侧耻骨上下支骨折6例,右侧耻骨上下支骨折4例;对照组中男6例,女4例,年龄(48.50±2.25)岁,左侧耻骨上下支骨折5例,右侧耻骨上下支骨折5例。对两组的手术时间、透视次数及出血量等数据进行统计分析。结果:两组性别、年龄、骨折分型差异无统计学意义。试验组手术时间为(31.0±5.3)min,术中透视次数为(3.5±2.1)次,出血量为(75.6±10.5)ml;对照组手术时间为(55.0±6.8)min,术中透视次数为(27.6±3.2)次,出血量为(85.5±12.5)ml。两组患者的手术时间及术中透视次数比较差异有统计学意义(P<0.05),两组出血量比较差异无统计学意义。结论:基于3D打印技术的个性化导向模板可实现逆向耻骨上支外侧髓内拉力螺钉置钉的精确置入,并且可以显著节省手术时间及减少患者及医护人员的射线暴露次数。

Objective：To evaluate the efficacy and advantages of personalized 3 D printing guided template of lateral superior ramous of pubic intramedullary lag screw. Methods：From July 2015 to December 2016,20 patients with the superior and inferior ramous of pubis fracture were treated with lag screws placement. All the patients were divided into test group（with guided template） and control group（with general operation）. There were 7 males and 3 females with an average age of（46.20±3.03） years old in test group and 6 males and 4 males with（48.50±2.25） years old in control group. There were 6 cases and 5 cases of superior and inferior branches fractures of pubic on the left side and 4 cases and 5 cases on the right side in two groups respectively. The operation time,perspective times and bleeding loss were compared between two groups. Results：The test group and the control group had no statistically significant relative to gender,age,fracture classification. The average time of surgery,average intraoperative fluoroscopy times,mean blood loss in test group were（31.0±5.3） min,（3.5±2.1） times,（75.6±10.5） ml respectively,and in control group were（55.0±6.8） min,（27.6±3.2） times,（85.5±12.5） ml respectively. There were significant Statistical differences between two groups（P〈0.05） in average operation time and average fluoroscopy times,however,mean blood loss had no significant differences between two groups（P〈0.05）. Conclusion：The personalized guide template based on 3 D printing technology could realize precise placement of the lateral intramedullary lag screw fixation in the superior branch of pubic,also could save the operation time and reduce the times of radiation exposure of patients and surgeons.