3D打印截骨导板辅助治疗胫骨骨折畸形愈合

3D printed guide template used in osteotomy for malunion of tibial fracture

目的探讨3D打印截骨导板在胫骨骨折畸形愈合截骨矫治术中的应用效果。方法回顾性分析2010年1月至2018年1月期间郑州大学第一附属医院骨科收治的30例胫骨骨折畸形愈合患者资料。根据治疗方法不同将患者分为2组:15例患者行3D打印截骨导板辅助截骨术治疗(3D打印组),男9例,女6例;年龄(46.3±8.2)岁;骨折畸形愈合位于胫骨中上段11例,胫骨下段4例;左侧6例,右侧9例;内翻畸形8例,外翻畸形7例;术前骨折畸形角度24.3°±5.5°。15例患者使用传统手术方法治疗(传统手术组),男10例,女5例;年龄(47.1±6.0)岁;骨折位于中上段12例,下段3例;左侧5例,右侧10例;内翻畸形7例,外翻畸形8例;术前骨折畸形愈合角度平均22.5°±5.4°。记录并比较两组患者术前一般资料、手术时间、术中出血量及术后下肢力线恢复情况。结果3D打印组和传统手术组胫骨骨折畸形愈合术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。3D打印组和传统手术组患者术后平均随访12、10个月。3D打印组手术时间较传统手术组明显缩短[(102.2±13.0)vs.(137.9±10.5)min],术中出血量较传统手术组明显减少[(77.3±39.7)vs.(163.3±35.2)mL],术后3D打印组畸形角度较传统手术组显著减小[(1.9°±0.4°)vs.(3.2°±0.9°)],以上项目两组间比较差异均有统计学意义(P<0.05)。末次随访时两组均未见内固定物松动,截骨处均实现愈合,未再次出现畸形,下肢力线恢复良好。结论3D打印截骨导板技术在辅助胫骨骨折畸形愈合的截骨治疗中能精准截骨,减少手术时间及术中出血量,有效纠正下肢力线,术后近期疗效良好,是胫骨骨折畸形愈合有效的辅助技术。

Objective To evaluate the personalized 3D printed guide template used in the osteotomy for malunion of tibial fracture.Methods A retrospective analysis was conducted of the 30 patients who had been treated for malunion of tibial fracture at Department of Orthopaedics,The First Affiliated Hospital to Zhengzhou University from January 2010 to January 2018.Of them,15 used a personalized 3D printed guide template in the osteotomy(3D printing group).They were 9 males and 6 females,with an age of 46.3 year±8.2 years.The fracture malunion was located in the upper and middle tibia in 11 cases,in the lower tibia in 4 cases,on the left side in 6 cases and on the right side in 9 ones.There were 8 cases of varus deformity and 7 ones of valgus deformity.Their preoperative fracture deformity angle was 24.3°±5.5°.The other 15 patients were treated with conventional surgery(conventional group).They were 10 males and 5 females,with an age of 47.1 years±6.0 years.The fracture was located in the upper and middle tibia in 12 cases,in the lower tibia in 3 cases,on the left side in 5 cases and on right side in 10 cases.There were 7 cases of varus deformity and 8 ones of valgus deformity.Their preoperative fracture deformity angle was 22.5°±5.4°.The 2 groups were compared in terms of preoperative baseline data,operation time,intraoperative blood loss and postoperative recovery of the alignment of lower limb.Results There were no significant differences in the preoperative baseline data between the 2 groups,showing comparability(P>0.05).The 3D printing group was followed up for an average of 12 months while the conventional group for an average of 10 months.The operation time for the 3D printing group was significantly shorter than that for the conventional group(102.2 min±13.0 min versus 137.9 min±10.5 min),the intraoperative blood loss for the former significantly less than that for the latter(77.3 mL±39.7 mL versus 163.3 mL±35.2 mL),and the postoperative malunion angle in the former significantly smaller than that in the latter(1.9°±0.4°versus 3.2°±0.9°)(all P<0.05).The last follow-ups revealed no implant failure or re-malunion but fine healing of the osteotomy sites and good recovery of the alignment of lower limb in the 2 groups.Conclusion A personalized 3D printed guide template used in the osteotomy for malunion of tibial fracture is an effective aid because it can facilitate precise osteotomy,reduce operation time and intraoperative blood loss and help correct the alignment of lower limb,leading to good short-term surgical outcomes.