3D打印技术应用于Rüedi-AllgöwerⅢ型Pilon骨折的临床疗效研究

The clinical effect of 3D printing in the treatment of Pilon fracture of Rüedi-AllgöwerⅢtype

目的探讨分阶段延期切开复位锁定加压钢板(locking compression plate,LCP)内固定联合3D打印技术治疗Rüedi-AllgöwerⅢ型Pilon骨折的临床疗效。方法2015年1月—2019年1月,本院骨科共收治22例Rüedi-AllgöwerⅢ型Pilon骨折患者,其中男17例,女5例;年龄21~63岁,平均(44.87±4.16)岁;受伤至手术时间10~14 d,平均(11.12±1.24)d。开放性骨折予伤口清创缝合闭创,对于踝关节脱位者予伤后手法复位,所有胫骨Pilon骨折均先行跟骨牵引制动,待局部软组织损伤控制后再延期行切开复位LCP内固定,术前行双侧踝关节3D打印,根据骨折模型进行术前规划、术中辅助、术后根据骨折类型和固定牢固程度指导功能锻炼。结果22例患者术后均随访1年,所有患者骨折均获愈合,平均愈合时间为6.5个月。按美国足踝外科学会(American orthopaedic foot and ankle society,AOFAS)功能评分标准评定疗效:优7例,良12例,可2例,差1例,优良率为86.4%。3例患者术后出现局部软组织并发症,通过换药等局部处理后均愈合。本组所有患者术后未出现内固定物松动、断裂等并发症。结论做好术前计划,选准手术时机,选准手术切口,分阶段延期切开复位LCP内固定联合3D打印技术治疗Rüedi-AllgöwerⅢ型Pilon骨折可有效减少局部并发症,使骨折能够按期愈合,并能获得较好的踝关节功能,是目前治疗Rüedi-AllgöwerⅢ型Pilon骨折一种行之有效的方法。

Objective To explore the clinical effect of the treatment of Pilon fracture of Rüedi-AllgöwerⅢtype with the combination of staged delayed open reduction and locking compression plate(LCP)internal fixation and 3D printing technology.Methods From January 2015 to January 2019,22 patients with Pilon fracture of Rüedi-AllgöwerⅢtype were admitted to our orthopaedic department,including 17 males and 5 females,aged 21~63 years with an average of(44.87±4.16)years,and the average time from injury to operation was 10~14 days with an average of(11.12±1.24)days.Open fractures were treated with debridement and suturing to close the wound,and those with ankle dislocation were treated with manual reduction after injury.All tibial Pilon fractures were treated with traction and braking of calcaneus.After the control of local soft tissue injury,LCP internal fixation was postponed.Before operation,3D printing of bilateral ankle joints was performed.According to the fracture model,preoperative planning,intraoperative assistance and postoperative fixation were performed solid degree guidance function exercise.Results All the 22 patients were followed up for one year,and all the fractures were healed,the average healing time was 6.5 months.According to the criteria of American orthopaedic foot and ankle society(AOFAS)function score,the curative effect was excellent in 7 cases,good in 12 cases,fair in 2 cases,and poor in 1 case.The excellent and good rate was 86.4%.Local soft tissue complications occurred in 3 patients after operation,and healed after local treatment such as dressing change.There were no complications such as loosening or rupture of internal fixation in all patients.Conclusion The treatment of Rüedi-AllgöwerⅢtype Pilon fracture can effectively reduce the local complications,enable the fracture to heal on time,and obtain better ankle function.It is an effective method to treat Rüedi-AllgöwerⅢPilon fracture at present.