3D打印结合微创撬拨克氏针固定在治疗Sanders Ⅱ、Ⅲ型跟骨骨折中的临床应用

Clinical application of 3D printing combined with minimally invasive prying and poking Kirschner wire fixation in the treatment of SandersⅡandⅢcalcaneal fractures

目的研究3D打印技术结合微创撬拨克氏针固定在治疗SandersⅡ、Ⅲ型跟骨骨折患者中的临床应用及疗效。方法回顾性分析2018年3月~2020年3月东莞市东部中心医院收治的56例SandersⅡ、Ⅲ型跟骨骨折患者的资料。研究对象分为3D打印结合微创撬拨克氏针固定治疗组(3D组)和常规切开复位钢板螺钉内固定组(传统组)各28例。其中,3D组术前打印1∶1的3D骨折模型,术前依据3D模型规划手术方案及模拟手术,制定并实施个性化方案;传统组行常规切开复位跟骨钢板螺钉内固定术。比较两组的手术时间、切口长度、失血量、住院时间、透视次数、术后并发症及Maryland评分。结果 56例患者术后获3~20个月(平均11.6个月)的随访。3D组均采取了术前模拟的手术方案与步骤,其手术时间、切口长度、失血量、住院时间较传统组少,差异有统计学意义(<0.05)。在术中透视次数上,3D组较传统组有所增加,两组间差异有统计学意义(<0.05)。在两组术后并发症上,3D组切口均Ⅰ期愈合,传统组术后切口并发症3例,两组均未出现内固定外露及骨髓炎等并发症。术后根据Maryland足部评分,两组患足功能比较,差异无统计学意义(>0.05)。结论 3D打印结合微创撬拨克氏针固定在SandersⅡ、Ⅲ型跟骨骨折的手术治疗上,可减少手术和住院时间,缩小手术切口,减少失血量,降低跟骨手术切口并发症的发生率,从而达到良好的临床疗效。

Objective To study the clinical application and curative effect of 3 D printing technology combined with minimally invasive prying and poking Kirschner wire fixation in the treatment of SandersⅡandⅢcalcaneal fractures.Methods The data of 56 SandersⅡandⅢcalcaneal fractures admitted from March 2018 to March 2020 were analyzed retrospectively in Dongguan East Central Hospital.The subjects were divided into two groups:3 D printing combined with minimally invasive prying Kirschner wire fixation group(3 D group,28 cases)and conventional open reduction and internal fixation group(traditional group,28 cases).3 D group printed 1:13 D fracture model before operation,planned operation plan and simulated operation according to 3 D model before operation,developed and implemented personalized plan.In the traditional group,conventional open reduction and plate screw internal fixation were performed.The operation time,incision length,blood loss,hospital stay,fluoroscopy times,postoperative complications and Maryland’s foot score were compared between the two groups.Results The 56 patients received a mean follow-up of 11.6 months(from 3 to 20 months).The operation time,incision length,blood loss and hospital stay of 3 D group were less than those of traditional group(P<0.05).In terms of intraoperative fluoroscopy times,3 D group was more than traditional group,and the difference was statistically significant(P<0.05).In the postoperative complications of the two groups,the incision in the 3 D group were healed in the first stage,traditional group incision complications in 3 cases,both groups did not appear internal fixation exposure and osteomyelitis and other complications.According to Maryland’s foot score,there was no significant difference between the two groups(P>0.05).Conclusion 3 D printing combined with minimally invasive Kirschner wire fixation in SandersⅡandⅢcalcaneus fracture surgery can reduce the operation and hospital stay,reduce the surgical incision,reduce blood loss,reduce the incidence of complications of calcaneal surgical incision,so as to achieve good clinical effect.