3D打印辅助桥接内固定系统治疗股骨多段骨折

3D printing-assisted bridge combined internal fixation system for the treatment of multiple fractures of the femur

目的探讨3D打印辅助桥接内固定系统个性化治疗股骨多段骨折的临床疗效。方法回顾性分析湛江中心人民医院2013年1月至2015年12月收治的9例股骨多段骨折患者的临床资料。根据患者术前CT扫描数据重建股骨多段骨折模型,借助3D打印技术打印1∶1实物模型,直接在模型上标记骨折线,清晰辨认移位骨折块,制订个性化固定方案并组装好桥接内固定系统各个模块,然后采用MIPPO技术进行内固定手术。记录手术时间、术中出血量、住院时间、骨折愈合时间及并发症发生情况,采用Harris髋关节功能评分及Lysholm膝关节评分评估末次随访时患肢髋膝关节功能。结果手术时间(159±29)min,术中出血量(544±133)m L,住院时间(17±4)d。随访时间6~33个月(平均19个月)。患者均获骨性愈合,骨折愈合时间(8.6±1.9)个月。末次随访Harris髋关节功能评分优7例、良2例,Lysholm膝关节评分优6例、良2例、差1例。1例术后出现膝关节僵硬,二期取出内固定时行膝关节松解术。随访期间无伤口感染、骨不愈合、内固定松动断裂并发症发生。结论 3D打印辅助桥接内固定个性化精准手术具有用时短、出血量少、安全可靠、功能恢复满意等特点,是治疗股骨多段骨折的较好选择。

Objective To explore the clinical effects of3D printing-assisted bridge combined internalfixation system in individualized treatment of multiple femoral fractures.Methods A retrospective study involvedclinical data of9patients with multiple femoral fractures treated from January2013to December2015in CentralPeople's Hospital of Zhanjiang.Reconstruction model of multiple femoral fracture was made according to preoperative CT scanning,1:1physical model was printed by the assistance of3D printing technology,and thenthe fracture line was marked on the models directly,so as to determine the dislocated fracture fragment clearly.Individualized fixation program was formulated,and modules of bridge combined fixation system were fixed wellbefore the surgery.After that,internal fixation was performed with MIPPO technique.Operation time,intraoperative estimate blood loss,hospitalization stay,fracture healing time and complications were recorded,hipand knee joint functions at the last follow-up were evaluated by Harris hip scoring and Lysholm knee scoringsystem respectively.Results The average operation time was(159±29)min,the average intraoperative estimateblood loss was(544±133)mL,and the average hospitalization stay was(17±4)d.The patients were followedup for6to33months,with an average of19months.All patients obtained bone union,with the bone healingtime of(8.6±1.9)months.At the latest follow-up,according to Harris hip scoring system,there was excellent in7,good in2cases;As for Lysholm knee score,there was excellent in6,good in2,poor in1case.One patienthad stiff knee joint and underwent knee arthrolysis,the internal fixation was also removed at the same time.During the follow-up period,there were no complications of surgical site infection,bone nonunion,loosening orrupture of internal fixation.Conclusions Individualized precision surgery with3D printing-assisted bridgecombined internal fixation system has the advantages of short operation time,less bleeding,safe and reliableprocedures,satisfactory functional recovery,and so on.As a result,it is a good choice for the treatment ofmultiple femoral fractures.