3D打印与桥接内固定系统联合治疗四肢骨折的效果观察

3D printing and bridging internal fixation system in the treatment of limb fractures

目的研究3D打印与桥接内固定系统联合治疗四肢骨折的效果。方法前瞻性研究2016年6月-2019年6月常州市第四人民医院骨科收治的四肢骨折患者90例,按照随机数字表法分为3D组和对照组,各45例。对照组术前接受常规影像学检查,3D组在对照组的基础上进行患肢骨折处的3D模型打印。3D组男性29例,女性16例;年龄20~40岁,平均31.2岁;致伤原因道路交通伤20例,坠落伤12例,殴打伤8例,病理性骨折5例。对照组男性30例,女性15例;年龄20~42岁,平均31.0岁;致伤原因道路交通伤18例,坠落伤13例,殴打伤5例,病理性骨折9例。两组均行桥接内固定手术,比较两组手术时间、术中出血量、术中透视次数、骨折愈合时间、术中麻醉药用量、住院时间、放置准确率;比较两组手术前后Enneking肢体功能评分、VAS评分、焦虑自评量表(SAS)评分及纤维蛋白原(FIB)、纤维细胞生长因子-2(FGF-2)和转化生长因子-β1(TGF-β1)血清水平;比较两组手术后并发症发生情况。结果3D组手术时间(89.7±7.5)min、术中出血量(215.76±10.38)mL、术中透视次数(3.0±0.4)次、术中麻醉药用量(197.5±14.9)mg、住院时间(15.8±2.5)d显著少于对照组(93.3±6.8)min、(235.28±10.47)mL、(3.5±0.5)次、(204.5±16.7)mg、(17.4±2.4)d,差异有统计学意义(t=2.385,8.882,5.238,2.098,3.097,P<0.05)。3D组术后Enneking评分显著高于术前及对照组术后,SAS评分显著低于术前及对照组术后,差异有统计学意义(t=16.171,2.054,8.403,2.496,P<0.05)。3D组手术后FGF-2、TGF-β1水平显著低于术前及对照组术后,差异有统计学意义(t=16.619,18.365,2.942,4.617,P<0.05)。3D组术后并发症总发生率为16%,显著低于对照组36%,差异有统计学意义(χ2=4.731,P<0.05)。结论3D打印与桥接内固定系统联合治疗四肢骨折有较好的效果,可加快患者术后恢复,减少手术出血及相关并发症,临床价值较高。

Objective To study the effect of 3D printing and bridging internal fixation system in the treatment of limb fracture.Methods From Jun.2016 to Jun.2019,90 patients with limb fracture were selected for prospective study.They were divided into observation group and control group according to the method of random number table,with 45 cases in each group.The control group received routine imaging examination before operation,and the observation group carried out 3D printing on the basis of the control group.In the observation group were 29 males and 16 females aged 20-40 years(average 31.2 years);fracture causes included road traffic injury in 20 cases,fall injury in 12 cases,beating injury in 8 cases,and pathological fracture in 5 cases.In the control group were 30 males and 15 females aged 20-42 years(average 31.0 years old);fracture causes included road traffic injury in 18 cases,fall injury in 13 cases,beating injury in 5 cases and pathological fracture in 9 cases.Both groups received bridging internal fixation system for treatment.The operation time,intraoperative blood loss,intraoperative fluoroscopy times,fracture healing time,intraoperative anesthetic dosage,hospitalization time and placement accuracy were compared between the two groups;The Enneking limb function score,pain visual analogue(VAS)score,self rating anxiety scale(SAS),fibrinogen(FIB),fibroblast growth factor-2(FGF-2)and transforming growth factor-β1(TGF-β1)serum levels before and after operation were compared between the two groups,and the complications after operation were compared.Results The operation time(89.7±7.5)min,intraoperative hemorrhage(215.76±10.38)mL,intraoperative fluoroscopy(3.0±0.4)times,intraoperative anesthesia(197.5±14.9)mg,and hospitalization time(15.8±2.5)d in the observation group were significantly less than those in the control group[(93.3±6.8)min,(235.28±10.47)mL,(3.5±0.5)times,(204.5±16.7)mg,(17.4±2.4)d].The differences were statistically significant(t=2.385,8.882,5.238,2.098,3.097,P<0.05).After operation,Enneking score in the observation group was significantly higher than that before and after operation in the control group,and SAS score was significantly lower than that before and after operation in the control group(t=16.171,2.054,8.403,2.496,P<0.05).The levels of FGF-2 and TGF-β1 in the observation group were significantly lower than those before operation and after operation in the control group(t=16.619,18.365,2.942,4.617,P<0.05).The total incidence of postoperative complications in the observation group was 16%,which was significantly lower than that in the control group(36%,χ2=4.731,P<0.05).Conclusion The combination of 3D printing and bridging internal fixation system has a good effect in the treatment of limb fracture,which can accelerate the postoperative recovery of patients,reduce the bleeding and related complications,and have a high clinical value.