3D打印技术在复杂肱骨近端骨折中的应用

Application of 3D printing technique to complex proximal humerus fractures

目的使用3D打印技术重建复杂骨折模型,探讨其在肱骨近端骨折中的作用。方法选取2015年6月—2017年6月收治的50例复杂肱骨近端骨折患者为本次研究对象,按照随机化原则将其平均分为两组,甲组患者进行常规治疗,乙组患者在常规治疗的基础上,使用3D打印技术重建骨折模型进行辅助治疗。比较两组患者手术持续时间、手术中出血量、骨折愈合时间以及手术中进行C臂透视的次数等临床相关资料,手术前和随访患者12个月后,使用Neer肩关节评分法(Neer评分)和CMS肩关节评分系统(CMS评分)对患者的肩关节功能进行评价。结果手术结束后比较两组患者临床相关指标,乙组患者各指标水平要优于甲组患者(P <0. 05),12个月后随访测定两组患者的Neer评分和CMS评分,与手术前的测定值进行比较,两组患者两项评分均有改善,两组之间进行比较,乙组患者得分要优于甲组患者,差异具有统计学意义(P <0. 05)。结论 3D打印技术使手术前进行模拟操作成为可能,让手术过程能够提前且更加直观地表现在医师面前,应用于复杂肱骨近端骨折的治疗中,能够缩短手术时间、减少手术过程中的出血量、缩短愈合时间等,还能够使肩关节功能得到更有效地恢复,大大提高了手术质量,可以进一步应用于骨折修复当中。

Objective To reconstruct complex fracture models using 3D printing technique and explore the role of 3D printing technique in treating proximal humeral fractures. Methods Fifty patients with complex proximal humeral fractures admitted from June 2015 to June 2017 were enrolled in this study,and were randomly divided into two groups.The patients in group A received conventional treatment,while the patients in group B received adjuvant therapy that complex fractures were reconstructed using 3D printing techniques in addition to conventional treatment.The clinical indicators of surgery duration,blood loss volume during surgery,fracture healing time,and the number of C-arm fluoroscopy during surgery were compared between the two groups.The Neer Shoulder Scale (Neer score) and the CMS shoulder scoring system (CMS score) were used before and 12 months after the surgery to evaluate the shoulder function of the patients. Results After the surgery,the clinical indicators of group B were better than those of group A ( P < 0.05). The Neer score and CMS score of the two groups were both improved after 12 months of follow-up.The scores of the patients in group B were better than those in group A,and the differences were statistically significant ( P <0.05). Conclusion 3D printing technique makes it possible to perform simulation surgery before real surgery,and present surgical procedures to physicians in advance and more intuitively.Applying the technique to the treatment of complex proximal humeral fractures can not only reduce operation time,bleeding volume during operation,and healing time,but also restore shoulder joint functions more effectively,greatly improving the quality of surgery,which deserves further applicaiton to fracture repair.