3D打印辅助钢板固定术治疗复杂踝关节骨折的临床效果观察

Three-dimensional printing-assisted plate fixation versus conventional surgery for complex ankle fractures

[目的]观察3D打印辅助治疗复杂踝关节骨折的临床效果。[方法]选择2014年1月～2017年6月本院骨科收治的复杂踝关节骨折患者76例作为研究对象,随机数字法分为2组,每组38例。3D组使用3D打印技术辅助手术治疗,传统组使用传统手术技术治疗。比较两组围术期相关指标、踝关节Kofoed评分和Olerud-Molander评分。[结果]所有患者均顺利完成手术。3D组手术时间、术中出血量、住院时间、开始活动时间均显著低于传统组,差异有统计学意义(P<0.05)。患者术后随访12～24个月,平均(19.36±2.37)个月。3D组临床骨折愈合时间为(83.64±12.55) d,显著小于传统组的(96.37±15.60) d,差异有统计学意义(P<0.05)。术后,两组Kofoed评分和Olerud-Molander评分均显著增加,3D组术后6个月和末次随访时Kofoed评分显著大于传统组,差异均有统计学意义(P<0.05),3D组术后1、3、6个月和末次随访时Olerud-Molander评分显著大于传统组,差异均有统计学意义(P<0.05)。[结论] 3D打印技术辅助手术治疗复杂踝关节骨折疗具有手术时间短、术中出血量少及住院时间短等优点,可有效加快骨折愈合,改善踝关节功能。

[Objective] To compared the clinical outcomes of 3D printing-assisted plate fixation versus conventional surgery for complicated ankle fractures. [Methods] From January 2014 to June 2017, 76 patients with complex ankle fractures were included into this study and divided into two groups by random numbers with 38 patients in each group. The patients in the 3D group had fractures fixed by 3D printing-assisted technique, while those in the conventional group received routine open reduction and internal fixation. The perioperative data were compared between the two groups, additionally ankle Kofoed score and Olerud-Molander score were applied for assessment of the clinical outcomes. [Results] All the patients had operation performed smoothly. The 3D group was significantly superior to the conventional group regarding to operation time, intraoperative blood loss, hospital stay and active motion time, with statistical differences between the two groups（P〈0.05）. The duration of follow up lasted for 12 to 24 months with an average of（19.36±2.37） months. The 3D group took statistically less time to get clinical healing of fractures than the conventional group [（83.64±12.55） d vs（96.37±15.60） d, P〈0.05]. Both Kofoed score and Olerud-Molander score in both groups significantly increased over time, with statistically significant differences among time points after operation（P〈0.05）. In comparison, the 3D group got statistically significantly higher aforesaid scores than the conventional group at each corresponding time point postoperatively（P〈0.05）. [Conclusion] The 3D printing-assisted plate fixation for complex ankle fracture takes benefits of shortening operation time, decreasing intraoperative blood loss, reducing hospital stay, accelerating fracture healing and improving functional recovery over the conventional technique.