3D打印技术在复杂髋臼骨折手术中的应用

Application of 3D printing technique in complicated acetabular fracture

目的探讨3D打印技术应用于复杂髋臼骨折手术治疗中的可行性和临床价值。方法回顾性分析承德医学院附属医院创伤骨科2015年8月至2017年1月行手术治疗的复杂髋臼骨折35例患者的临床资料。其中10例患者采用3D打印技术制定手术方案,男8例,女2例,平均年龄(43.0±12.9)岁,均于术前模拟骨折的复位及固定过程。25例患者采取常规手术治疗,男21例,女4例;平均年龄(45.5±12.8)岁。记录两组的手术时间、术中失血量、术中C型臂透视次数,同时记录围手术期输血量、术后引流量,并使用Matta评分对两组手术复位满意程度进行比较。结果 10例患者手术与术前计划一致,3D组和常规组手术时间平均分别为(177.0±51.2)min、(234.0±72.5)min,术中失血量平均分别为(1150.0±250.6)m L、(1528.0±399.5)m L,围手术期输血量平均为(880.0±214.9)m L、(1328.8±642.6)m L,术中透视次数平均为(8.8±2.1)次、(11.4±3.1)次,以上项目两组间比较差异均有统计学意义(均P<0.05)。术区引流量平均为(329.0±111.7)m L、(394.4±267.3)m L,采用Matta评分结果:优良率分别为70%(7/10)、72%(18/25),两组间比较差异无统计学意义(P>0.05)。结论 3D打印技术应用于复杂髋臼骨折的治疗临床可行性良好,有助于术者制定详细的术前计划,缩短手术时间,减少失血量,提高围手术期安全性。

Objective To evaluate the feasibility and clinical value of 3 D printing technique in the treatment of complex acetabular fractures. Methods We collected 35 patients＇ clinical information of Chengde Medical College Affiliated Hospital in August 2015 to January 2017 with surgical treatment of complex acetabular fractures. Ten cases were treated with 3 D printing technique,8 cases were male patients and 2 cases were female patients. The mean age was（ 43. 0 ±12. 9） years old,and in the preoperative simulation of fracture reduction and fixation process. Twenty-five patients underwent conventional surgery,21 males and 4 females with an average age of（ 45. 5 ± 12. 8） years. The operation time,intraoperative blood loss,intraoperative C-arm fluoroscopy were recorded,and the perioperative blood transfusion and postoperative drainage were recorded. Results Ten patients were consistent with preoperative planning. The average operation time of the 3 D group and the conventional group were（ 177. 0 ± 51. 2） min and（ 234. 0 ± 72. 5） min respectively. The average blood loss was（ 1150. 0 ± 250. 6） m L and（ 1528. 0 ± 399. 5） m L respectively. The average blood transfusion was（ 880. 0 ± 214. 9） m L,（ 1328. 8 ± 642. 6） m L,the average number of intraoperative fluoroscopy was（ 8. 8 ± 2. 1） times,（ 11. 4 ± 3. 1） times,the difference between the two groups were statistically significant（ P〈0. 05）. The average drainage rate was（ 329. 0 ± 111. 7） m L and（ 394. 4 ± 267. 3） m L. The radiographic findings of ac-etabular fractures were evaluated by Matta score. The excellent and good rates were 70%（ 7/10） and 72%（ 18/25）respectively. There was no significant difference between the two groups（ P〉0. 05）. Conclusion The application of3 D printing technique in the treatment of complex acetabular fractures is of good clinical feasibility,which can help the patients to develop detailed preoperative planning,shorten the operation time,reduce the blood loss and improve the perioperative safety.