髋臼骨折术前规划中3D打印技术虚拟手术模拟的应用

Clinical application of virtual surgery simulation using 3D printing technique in preoperative planning of acetabular fracture

目的分析髋臼骨折术前规划中应用3D打印技术虚拟手术模拟的临床价值。方法选取2014年7月至2017年6月太和医院70例髋臼骨折患者进行研究。按照随机数字表法,随机分为观察组和对照组,每组35例。观察组术前规划应用3D打印技术虚拟手术模拟,对照组术前规划应用传统影像学观察。观查两组患者手术时间、术中出血量、围手术期输血量、术中透视次数等手术相关指标。对患者进行术后随访,并通过双下肢长度改善程度、视觉模拟评分(VAS评分)、Matta评分、Majeed评分等指标比较术后疗效,观察两组患者的术后并发症发生情况。结果观察组的手术时间、术中出血量、围手术期输血量、术中透视次数等指标均低于对照组,差异有统计学意义(P均<0.01)。两组治疗后的双下肢长度改善程度差异无统计学意义(P>0.05);观察组和对照组的Matta评分优良率(80.0%vs 77.1%)、Majeed评分[(87.0±4.2)分vs(84.5±3.8)分]及优良率(85.7%vs 82.9%)比较差异均无统计学意义(P均>0.05);观察组VAS评分低于对照组,差异有统计学意义[(1.7±0.4)分vs(3.3±1.2)分,P<0.05]。术后两组并发症发生率差异无统计学意义(P>0.05)。结论髋臼骨折术前规划中应用3D打印技术虚拟手术模拟,有助于提高术前诊断质量,手术操作更加准确、高效,可减少患者术后疼痛。

Objective To analyze the clinical value of 3 dimensions（ 3D） printing and surgery simulation of acetabular fracture. Methods Seventy cases of acetabular fracture patients treated from July 2014 to June 2017 were studied,and the patients were divided into observation group and control group（ n = 35 each） according to random number table method.The 3D printing and virtual surgery simulation in preoperative planning was used in observation group,and traditional image observation before surgery was used in control group. The operative-related indexes including operation time,intraoperative blood loss,perioperative blood transfusion volume and intraoperative fluoroscopy time in two groups were observed. The patients were followed up after operation. The curative effect was compared by improvement degree of lower limbs length,visual analogue score（ VAS） score,Matta score,Majeed score and the postoperative complications in two groups. Results The operation time,intraoperative blood loss,perioperative blood transfusion volume and intraoperative fluoroscopy times in observation group were significantly lower than those in control group（ all P〈0. 05）. There was no significant difference in the improvement degree of the lengths in both lower limbs between two groups（ P〈0. 05）. The VAS score in observation group was significantly lower than that in control group（ 1. 7 ± 0. 4 vs 3. 3 ± 1. 2,P〈0. 05）. There were no significant differences in Majeed score（ 87. 0 ± 4. 2 vs 84. 5 ± 3. 8,P〈0. 05） and the excellent/good rates of Matta score（ 80. 0% vs77. 1%,P〈0. 05） and Majeed score（ 85. 7% vs 82. 9%,P〈0. 05） between two groups. There was no significant difference in the incidence of postoperative complications between two groups（ P〈0. 05）. Conclusion The virtual surgery simulation using 3D printing technique in preoperative planning of acetabular fracture is helpful to improve the quality of preoperative diagnosis and has the advantages of more accurate and highly efficient to operation and lighter postoperative pain.