3D打印技术联合腹直肌外侧入路手术治疗髋臼骨折

3-D printing combined with lateral rectus abdominis approach for the treatment of acetabular fracture

目的探讨3D打印技术联合腹直肌外侧切口在治疗髋臼骨折的可行性和临床疗效。方法回顾性分析2014年1月—2017年12月在广州中医药大学顺德医院采用3D打印技术联合腹直肌外侧切口治疗的髋臼骨折患者,共32例。男性20例,女性12例;年龄17～65岁,平均39. 59岁。术前3D打印骨盆模型、模拟手术并预弯钢板。术中采用腹直肌外侧切口对骨折进行复位、钢板螺钉内固定。记录患者手术时间、术中出血量、切口长度、骨折暴露时间(从切开皮肤到暴露髋臼骨折时间)。应用Matta评价标准评估患者骨折复位情况以及Harris标准评价髋关节功能。结果患者均顺利完成手术。手术时间(148. 00±44. 82) min,术中出血量(445. 31±194. 42) m L,切口长度(7. 88±1. 29) cm,骨折暴露时间(13. 50±2. 71) min。按Matta影像学标准评价术后X线片:优15例,良12例,优良率84. 38%。术后髋关节功能按Harris标准评价:优14例,良10例,可8例,优良率75. 00%。结论 3D打印技术联合腹直肌外侧切口治疗髋臼骨折方法可行,术前3D打印骨盆模型可模拟手术。该入路具有切口小、暴露骨折端快、骨折复位好、出血少等优点。

Objective To investigate the clinical efficacy and superiority of three-dimensional printing combined with lateral rectus abdominis approach in the treatment of acetabular fractures.Methods A retrospective analysis was made on 32 patients with acetabular fractures treated by 3D printing combined with lateral rectus abdominis approach in Shunde Hospital of Guangzhou University of Traditional Chinese Medicine from Jan.2014 to Dec.2017.There were 20 males and 12 females,with an average of 39.59 years(range,17 to 65 years).Preoperative 3D printing of pelvic model and simulated surgery and pre-bending steel plates were applied.During the operation,the lateral rectus abdominis incision was used to reduce the fracture and fix the plate screw.The patients'operation time,intraoperative blood loss,incision length,and fracture exposure time(time from skin incision to acetabular fractures exposure)were recorded.The Matta evaluation criteria was used to assess fracture reduction in patients and the Harris criteria was used for evaluating hip function.Results All patients were successfully completed the operation.The operation time was(148.00±44.82)min,the amount of bleeding was(445.31±194.42)mL,the length of incision was(7.88±1.29)cm,and the exposure time of fracture was(13.50±2.71)min.Postoperative X-ray films were evaluated according to Matta imaging criteria:excellent in 15 cases,good in 12 cases,and the excellent and good rate was 84.38%.Postoperative hip function was evaluated according to Harris criteria:excellent in 14 cases,good in 10 cases,fair in 8 cases,and the excellent and good rate was 75.00%.Conclusion 3D printing technique combined with lateral rectus abdominis approach is feasible for acetabular fracture.It can simulate the operation and make accurate surgical plan before operation.This method has advantages of small incision,quick exposure of fracture ends,good reduction of fracture and less bleeding during operation.