3-D打印技术在青少年胫骨近端骺损伤骨折诊治中的应用

Application of 3-D printing technology in the diagnosis and treatment of proximal epiphyseal fracture of tibia in adolescents

目的探究3-D打印技术在青少年胫骨近端骺损伤骨折手术中应用的可行性。方法回顾分析2014年1月至2016年3月收治的8例胫骨近端骺损伤骨折患者临床资料。患者术前均收集CT数据,在Mimics软件中行骨折三维重建,导出1∶1实体模型,并在模型上模拟手术方案,术中操作按术前计划完成。术后支具制动,早期功能锻炼,观察并记录患肢生长及骨折愈合情况,术后12个月按改良Hohl和Luck膝关节评分标准行膝关节功能评分。结果患者术后均随访12~18个月,平均15.3个月,所有患者均骨性愈合,术后12个月膝关节评分优良率为100%;术后复查行双下肢全长轴线片对比,未见骨骺早闭、膝关节内外翻及关节不稳等并发症;术后12个月患肢活动度及生长长度与健侧比较,差异无明显统计学意义(P>0.05)。结论 3-D打印技术对青少年胫骨近端骺损伤骨折诊治有很强的临床指导作用。

Objective To investigate the feasibility of 3-D printing technology in the application of proxi-mal tibial epiphyseal injury fracture surgery for teenagers. Methods Clinical materials of the 8 patients with proxi-mal tibial epiphyseal injury fracture who were admitted to our hospital from January 2014 to March 2016 were retro-spectively analyzed. CT data of all patients was collected before the surgery and was used for fracture 3-D recon-struction with Minics software to print out the 1∶1 physical model. Meanwhile,surgical simulation was carried outon the 3-D model to design the internal fixation scheme,and all intraoperative operations were implemented in linewith the preoperative planning. Postoperative brace immobilization and the early-stage function exercise were takenand growth situation of the affected limbs and fracture healing were observed and recorded. In line with the modifiedHohl and Luck knee score standards,knee functional score was taken 12 months after the surgery. Results All pa-tients received postoperative follow-up service for 12 to 18 months,with the average of 15.3 months. All patientswere bony union,with the excellent knee score rate of 100%. The full-length axis of two limbs was compared be-tween the postoperative reexamination and no premature skeleton closure. Pronation and supination of the knee,un-stable joints and other complications were investigated. No obvious differences were found among the activity of theaffected limbs and 12-month growth length after the surgery and that of the uninjured side. Conclusions 3-Dprinting technology is a strong clinical guidance to the treatment of proximal tibial epiphyseal injury fracture surgeryfor teenagers.