3D打印技术在桡骨远端骨折复位内固定手术中的应用

Application of 3D printing in reduction and internal fixation for treatment of distal radius fractures

目的探讨3D打印技术在桡骨远端骨折复位内固定手术中的应用价值。方法选取30例正常成人双侧腕关节CT数据,应用Mimics 17.0软件建立腕关节三维模型,获取双侧腕关节解剖参数并进行比较。将2015年2月至2016年4月深圳市龙岗区骨科医院收治的79例桡骨远端骨折患者根据患者意愿分为2组,其中3D打印组采用3D打印技术辅助切开复位内固定手术,术前以健侧腕关节三维镜像为模板进行模拟复位,3D打印骨折模型,选择合适内固定物;常规手术组采用切开复位内固定手术。评估两组术中及术后疗效指标并进行比较。结果 30例正常成人双侧腕关节掌倾角及尺偏角比较,差异无统计学意义(P <0.05),表明以健侧腕关节三维镜像作为复原标准是可行的。50例患者获得随访,随访时间15～24个月,平均随访时间18.1个月。3D打印组入院至手术时间明显长于常规手术组,术中出血量、手术时间、术后15个月VAS评分明显低于常规手术组(P <0.05)。两组术后掌倾角、尺偏角均较术前明显改善(P <0.05),组间比较无明显差异,但3D打印组更接近于正常水平;腕关节功能优良率3D打印组高于常规手术组(84%vs 76%),但差异无统计学意义(P>0.05)。结论与传统手术相比,以健侧镜像为复位模板的3D打印辅助下桡骨远端骨折复位内固定具有精准化、个性化的特点,尽管术前准备时间较长,但创伤小、手术时间短,缓解疼痛更加有效。

Objective To discuss the application of 3D printing in open reduction and internal fixation （ORIF） for distal iadius fracture. Methods A total of 30 healthy adults were selected and their CT data of normal wrists were input into Mimics 17.0 software to construct 3D wrist models, then the anatomic parameters of bilateral wrists were compared statistically. According to patients＇ choices, 79 patients with distal radius fracturestreated from February 2015 to April 2016 in Longgang District Orthopaedics Hospital of Shenzhen were divided into 3D printing group and conventional surgical group. Patients in conventional group were carried out traditional ORIF; while patients in 3D printing group underwent 3D printing assisted ORIF, that is, before the operation, healflly wrist 3D images were regarded as templates, based on it, reduction procedure was simulated, fracture models were printed, and appropriate fixations were determined. Intzaoperative and postoperative efficacy indexes were evaluated and compared between two groups. Results There was no statistical difference between the bilateral wrists of 30 normal adults when compared the volaJc tilt angle and ulnar inclination angle, which suggested the feasibility of using 3D images of healthy side of the wrist joint as reduction criteria. Fifty patients were followed up, with the average follow-up time of 18.1 months （15-24 months）. Time from admission to operation in 3D printing group was longer than that in conventional group, while intraoperative estimate blood loss, operation time, score of visual analogue scale at 15 months after the operation in 3D printing group were lower than those in conventional group （P 〈0.05）. Volar tilt angle and ulnar inclination angle in two groups all improved after the operation （P 〈0.05）; similar postoperative results were found between two groups, but the parameters in 3D printing group were closer to normal levels; excellent and good rate of wrist function in 3D printing group was higher than that in conventional group （84% vs 76%）, but no statistical difference was found between two groups （P 〉0.05）. Conclusion In the treatment of distal radius fracture, precise and personalized 3D printing-assisted ORIF which using 3D images of healthy side of the wrist joint as reduction template, has the advantages of less trauma, shorter operation time and more obvious relief of pain when compared with conventional ORIF