3D打印技术配合预制接骨板在骨关节创伤微创治疗中的应用研究

Application of 3D printing technology combined with prefabricated bone plate in minimally invasive treatment of bone and joint trauma

目的:探讨3D打印技术配合预制接骨板在骨关节创伤微创治疗中的应用价值。方法:回顾性分析53例骨关节创伤病例,根据相同部位骨折随机分配方法,将患者分为两组:采用3D打印技术配合预制接骨板微创手术治疗的微创组27例,其中肱骨上段骨折1例,胫骨平台骨折9例,胫骨远端骨折17例;采用传统的切开复位内固定手术治疗的为对照组26例,其中肱骨上段骨折2例,胫骨平台骨折9例,胫骨远端骨折15例。微创组病例进行骨骼影像三维重建,利用3D打印技术将影像数据进行制作成型,采用体外模型分析诊断,制定手术计划,模拟复位,选择接骨板进行预制,模拟固定。术中采用微创复位固定。术后与对照组病例的手术时间、术中出血量、术后肢体血运情况、切口愈合效果、早期功能情况等进行比较。结果:微创组与对照组术后获得平均随访12.9个月。两组患者手术时间平均分别为(90.8±10.7)min、(111.9±11.3)min,组间比较差异有统计学意义(t=6.982,P=0.000)。微创组与对照组术中出血量平均分别为(137.2±12.6)ml、(358.5±11.7)ml,组间比较差异有统计学意义(t=66.194,P=0.000)。微创组手术切口较对照组明显小,对软组织创伤轻。两组所有病例均获得骨性愈合。根据关节功能评价评定疗效,微创组优16例,良11例;对照组优9例,良8例,可9例。优良率83%。结论:3D打印技术配合预制接骨板治疗骨关节损伤,能减小手术创伤,缩短手术时间,降低输血风险,提高手术的精确度和准确性,提高痊愈率,减少手术并发症。

Objective:To explore the application value of 3D printing technology combined with prefabricated bone plate in minimally invasive treatment of bone and joint rauma.Methods:From July 2015 to December 2018,53 cases of bone and joint trauma were retrospectively analyzed and randomly divided into two groups according to the fracture site.27 cases of minimally invasive group treated with 3D printing technology and prefabricated bone plate minimally invasive surgery,including 1 case of upper humerus fracture,9 cases of tibial plateau fracture and 17 cases of distal tibia fracture.In the control group,26 cases were treated with traditional open reduction and internal fixation,including 2 cases of upper humerus fracture,9 cases of tibial plateau fracture,and 15 cases of distal tibia fracture.In the minimally invasive group,3D bone image reconstruction was carried out and 3D printing technology was used to materialize the image data.On 3D materialized model analysis and diagnosis were adopted,surgical plans were made,simulated reduction was simulated and bone plates were prefabricated and fixated on 3D model.Minimally invasive reduction and fixation were used intraoperatively.The operation time,degree of soft tissue swelling,blood circulation,wound healing effect and early functional status were compared with conventional operation.Results:The minimally invasive group and control group were followed up for an average of 12.9 months.The average operating time of patients in the two groups was(90.8±10.7)min and(111.9±11.3)min.The difference between the two groups was statistically significant(t=6.982,P=0.000).The average intraoperative blood loss in the minimally invasive group and the control group was(137.2±12.6)ml and(358.5±11.7)ml.The difference between the groups was statistically significant(t=66.194,P=0.000).The incisions in minimally invasive group were significantly smaller than those in control group,and the soft tissue trauma was mild.All cases in both groups obtained bone healing.According to the evaluation of joint function,16 cases were excellent in minimally invasive group and 11 cases were good.In the control group,9 cases were excellent,8 cases were good,and 9 cases were acceptable.The excellent and good rate is 83%in minimally invasive group.Conclusion:3D printing technology combined with prefabricated bone plate in the treatment of bone and joint injuries can reduce surgical trauma,shorten the operation time,reduce the risk of blood transfusion,improve the accuracy and accuracy of surgery,improve the recovery rate and reduce surgical complications.