基于3D打印的锁骨中段移位骨折微创手术与传统切开复位内固定术的病例对照研究

Case control study on minimally invasive surgery and conventional open plating for displaced midshaft clavicular fracture based on 3D print

目的:比较基于3D打印技术的锁骨中段移位骨折微创手术与传统切开复位内固定术的临床疗效。方法:回顾性分析2016年7月至2016年12月采用3D打印微创手术与常规手术治疗的40例锁骨中段移位骨折患者的临床资料。根据手术切口不同以及是否采用3D打印技术将40例患者分为3D打印微创手术组和常规手术组。3D打印微创手术组(A组)20例,男11例,女9例;年龄19～57 (37.2±9.3)岁;骨折Robinson分型,2A2型4例,2B1型9例,2B2型7例。常规手术组(B组)20例,男13例,女7例;年龄17～54(35.1±9.5)岁;骨折Robinson分型,2A2型5例,2B1型8例,2B2型7例。观察并记录两组患者手术时间、出血量、切口长度、骨折愈合时间、并发症情况,并于术后12个月采用DASH评分及Constant评分对肩关节功能进行评价。结果:40例患者获得随访,时间12～18(15.1±2.0)个月。所有患者达到骨性愈合,A组愈合时间12～18(14.3±1.7)个月,B组11～18(14.4±1.9)个月,两组比较差异无统计学意义(P>0.05)。两组患者术中出血量比较差异无统计学意义(P>0.05);A组手术时间、创口长度明显小于B组(P<0.05)。术后12个月随访时两组患者肩关节DASH评分及Constant评分比较差异无统计学意义(P>0.05)。A组出现并发症1例,B组出现并发症6例,两组比较差异有统计学意义(P<0.05)。结论:基于3D打印的锁骨中段移位骨折微创治疗可以有效解决微创手术中的一些难点,达到与传统切开复位内固定相似的骨折愈合及功能恢复,同时切口更美观,手术时间更短,手术相关并发症更少。

Objective:To compare clinical effect of minimally invasive surgery and conventional open plating for acute displaced midshaft clavicle fracture based on 3D-print. Methods:From July 2016 and December 2016,40 patients with acute displaced midshaft clavicle fractures were retrospectively analyzed. The patients were divided into 3D minimally invasive surgery group(group A) and conventional open plating group(group B) according to different surgical incisions and whether to use 3D printing. In group A,including 11 males and 9 female,aged from 19 to 57 years old with an average of(37.2±9.3)years old;type 2A2 were 4 patients,type 2B1 were 9 patients and type 2B2 were 7 patients according to Robinson classification. In group B,including 13 males and 7 female,aged from 17 to 54 years old with an average of(35.1±9.5) years old;type2A2 were 5 patients,type 2B1 were 8 patients and type 2B2 were 7 patients according to Robinson classification. Operative time,blood loss,length of incision,fracture healing time,complications were observed and compared between two groups,DASH score and Constant score of shoulder joint were evaluated at 12 months after operation. Results:Forty patients were followed up from 12 to 18 months with an average of(15.1±2.0) months. All fractures were healed,healing time in group A ranged from 12 to 18 months with an average of(14.3±1.7) months,in group B ranged from 11 to 18 months with an average of(14.4±1.9) months,while there was no statistical differences between two groups(P >0.05). No differences in blood loss between two groups(P >0.05). Operative time,length of incision in group A was less than that of group B(P<0.05). There were no significant differences in DASH score and Constant score at 12 months between two groups(P >0.05). One patient in group A occurred complication,and 6 patients in group B occurred compilations,and has statistical differences between two groups(P<0.05). Conclusion:Minimally invasive technique based on 3D print could resolve some difficulties of minimally invasive surgery effectively and achieve fracture healing and functional recovery similar to traditional open reduction with more beautiful incision,less complication,shorter operation time.