3D打印与LCP分别联合MIPO技术治疗成人NeerⅡ、Ⅲ型肱骨近端骨折的临床效果

Clinical value of 3D printing and LCP combined MIPO method in the treatment of adult Neer Ⅱ and Ⅲ proximal

目的探讨3D打印与LCP分别联合MIPO技术治疗成人NeerⅡ、Ⅲ型肱骨近端骨折的临床效果。方法选取2017年1月-2018年6月在东莞康华医院创伤骨科住院并进行手术的肱骨近端骨折60例作为研究对象,随机分为试验组和对照组,每组各30例。试验组采用3D打印联合微创经皮接骨技术(MIPO)进行治疗,对照组采用锁定加压钢板(LCP)联合MIPO进行治疗。通过Neer评分对术后肩关节功能进行评估。观察并比较2组患者的手术时间、术中出血量、骨折愈合时间、术后并发症、Neer评分。结果试验组手术时间明显短于对照组,且术中出血量明显少于对照组,差异有统计学意义(t=2.631、4.167,P<0.05);2组骨折愈合时间差异无统计学意义(P>0.05);试验组手术后12个月时,Neer评分中4项均优于对照组,差异具有统计学意义(P<0.05)。2组术后均获愈合,试验组随访过程中均未出现无骨不连、内固定松动或断裂、切口感染等并发症,无肱骨头坏死及神经损伤。对照组有1例患者术后螺钉松脱,肩关节活动没有受到明显影响。结论 3D打印联合MIPO技术是治疗成人NeerⅡ、Ⅲ型肱骨近端骨折合理可行的方法,可提高复位质量,便于手术操作,缩短手术时间以及减少术中出血量,有利于肩关节功能的恢复。

Objective To analyze the value of closed pry reduction and percutaneous hollow screw fixation combined with 3D printing technique in the treatment of calcaneal fracture. Methods 60 hospitalized patients with proximal humeral fractures in the department of Orthopaedics of Dongguan Kanghua Hospital from January 2017 to June 2018 were randomly divided into experimental group and control group with 30 cases in each group. The experimental group was treated with 3D printing combined with minimally invasive percutaneous osteosynthesis(MIPO), while the control group was treated with locking compression plate(LCP) combined with MIPO. The shoulder function was assessed by Neer score. The operative time, intraoperative blood loss, fracture healing time, postoperative complications and Neer score were observed and compared between the two groups. Results The operation time of the experimental group was shorter than that of the control group, and the amount of bleeding during the operation was less than that of the control group, the difference was statistically significant(t=2.631, 4.167,P<0.05). There was no significant difference in fracture healing time between two groups(P>0.05). In the experimental group, 4 Neer scores in December were better than those in the control group, and the difference was statistically significant(P<0.05). There were no complications such as nonunion, loosening or rupture of internal fixation, infection of incision, necrosis of humeral head and nerve injury during follow-up in the experimental group. In the control group, 1 patients had screw loosening after operation, and shoulder joint activity was not significantly affected. Conclusion 3D printing combined with MIPO technology is a reasonable and feasible method for treating adult Neer type II and III proximal humeral fractures. It can improve the reduction quality, facilitate the operation, shorten the operation time and reduce the amount of bleeding during the operation, and is conducive to the recovery of shoulder joint function.