3D打印技术在桡骨远端不稳定性骨折微创治疗中的应用

Clinical application value of 3D printing technology in the mini-invasive treatment of unstable distal radius fractures

目的:探讨3D打印技术辅助下微创手术在桡骨远端不稳定性骨折治疗中的临床应用。方法:选取桡骨远端不稳定性骨折病人25例,分为3D打印技术辅助下微创(闭合或有限切开)复位克氏针内固定外固定支架外固定组(MIS组)12例和切开复位锁定板内固定组(ORIF组)13例。比较2组病人手术时间和切口长度,术后随访病人腕关节掌屈、背伸、尺偏、桡偏、旋前、旋后六个方向的活动度,复查腕关节正侧位片,观察对掌倾角、尺偏角、桡骨长度及关节面恢复情况,应用Gartland-Werley腕关节功能评分表对2组病人腕关节功能进行评分并比较。结果:2组病人均顺利完成手术,MIS组手术时间明显短于ORIF组(P<0.01),手术切口长度明显小于ORIF组(P<0.01)。2组病人术后腕关节均复位良好,腕关节活动度和功能评分优良率差异均无统计学意义(P>0.05)。结论:应用3D打印技术辅助下微创(闭合或有限切开)复位克氏针内固定外固定支架外固定治疗桡骨远端不稳定性骨折,切口小,手术时间短,腕关节功能恢复良好,且可避免二次手术。

Objective:To investigate the clinical application value of 3D printing technology in the mini-invasive treatment of unstable distal radius fractures. Methods:Twenty-five patients with unstable distal radius fracture were divided into the MIS group(12 cases) and ORIF group(13 cases). The MIS group and ORIF group were treated with mini-invasive surgery reduction(close reduction or limited incision reduction) combined with external fixation assisted by 3D printing technology,and open reduction combined with internal fixation, respectively. The operation time, incision size and postoperative following-up of the activity of wrist motion (palmarflexion,dorsiflexion,ulnardeviation,radialdeviation,pronation,supinaion) were compared between two groups. The recovery of palmar inclination,ulnar deviation,radial length and joint surface in two groups were observed using the positive and lateral wrist radiographs. According to Gartland-Werley scoring criteria,the wrist joint function between two groups was evaluated and compared. Results:The operation in two groups was successfully completed,and the average operation time and incision length in MIS group were less than those in ORIF group(P < 0. 01). The recovery of wrist joint function in two groups was good,and the differences of the excellent and good rate of the activity of the wrist motion,and score of wrist joint function between two groups were not statistically significant(P >0. 05). Conclusions:The mini-invasive surgery reduction(close reduction or limited incision reduction) combined and external fixation assisted by 3D printing technology combined with open reduction and internal fixation in the treatment of the unstable distal radius fractures has little incision,short operation time and good recovery of wrist joint function,which can avoid secondary surgery.