数字化设计结合3D打印技术治疗复杂胫骨平台骨折的效果评价

Evaluated the digital design combined with three-dimensional printing technique in the treatment of complicated tibial plateau fractures

目的研究数字化设计结合3D打印技术辅助手术治疗复杂胫骨平台骨折的效果。方法回顾性分析20例复杂胫骨平台骨折患者采用数字化设计结合3D打印技术辅助进行手术资料。术前收集复杂胫骨平台骨折病例及常用的胫骨平台钢板的CT数据扫描建立标准件库,利用Mimics软件辅助植入钢板及螺钉,记录手术时间、术中出血量、骨折愈合时间、钢板一次性放置准确率、术后并发症、术前术后胫骨平台内翻角及内外侧后倾角度数、术后膝关节功能Rasmussen评分和末次随访时的纽约特种外科医院膝关节评分(HSS)。结果 20例患者随访时间12~30个月(平均17.6个月),骨折均完全愈合,X线影像学平均愈合时间为11.4周,平均手术时间为(84.40±13.21)min,术中平均失血量(350±14.24)mL,钢板一次性放置准确率100%。术后即刻随访X线Rasmussen评分:优15例,良4例,可1例,优良率为95%;术后12个月随访时膝关节HSS评分:优14例,良4例,可2例,优良率为90%。术后即刻及3、12个月TPA及内外侧平台PA较术前明显恢复,差异均有统计学意义(P<0.05);术后即刻及3、12个月的胫骨平台TPA及内外侧平台PA之间比较差异均无统计学意义(P>0.05)。外侧切口皮缘部分坏死、感染1例,术后出现腓总神经损伤症状1例。结论数字化设计结合3D打印技术应用于复杂胫骨平台骨折有助于制订术前计划、术中精确复位,临床效果满意,可实现精准化、个体化治疗。

Objective To investigate the effect of digital design combined with three-dimensional printing technique in the treatment of complicated tibial plateau fractures.Methods A retrospective analysis was performed on 20 cases of complicated tibial plateau fractures assisting surgery by digital design combined with three-dimensional printing technique. The standard parts library was established by collecting the CT data of complex tibial plateau fractures and commonly used tibial plateau plates before operation. Mimics software was used to assist the implantation of plate and screw. The data were documented regarding operation time,intraoperative bleeding,fracture healing time,one-time accuracy of plate placement and postoperative complications,tibial plateau angle and posterior slope angle on radiography between preoperation and postoperation,Rasmussen score and Hospital for Sepcial Surgery( HSS) knee score to assess functions of the involved knees at the final follow-ups. Results 20 patients were followed up for an average of 17. 6 months( range from 12 to 30 months). The average healing time of fracture was 11. 4 weeks( range from 9 to 14 weeks) and the average operation time was 84. 40 ± 13. 21 minutes. The average blood loss during operation was( 350 ± 14. 24) m L,The accuracy rate of plate placement was100%. The Rasmussen’s radiological grading scored was 15 excellent cases,4 good cases and 1 fair case( excellent and good rate95%). The Hospital for Special Surgery score was 14 excellent cases,4 good cases and 2 fair cases( excellent and good rate 90%) of all the patients at 12 months postoperative. TPA and PA in the tibial plateau immediately,3 months and 12 months after operation had significant difference compared with those before operation( P < 0. 05);while there were no significant differences between TPA and PA in the tibial plateau immediately,3 months and 12 months after operation( P > 0. 05). There were one case of partial necrosis in the skin margin of lateral incision,and one case of common peroneal nerve injury after operation. Conclusion The application of digital design combined with 3 D printing technique in complex tibial plateau fracture is helpful for making preoperative plan,accurate reduction during operation,satisfactory clinical effect and precise and individualized treatment.