3D打印术前模拟手术固定辅助治疗胫骨平台陈旧骨折

3D printing preoperative simulated surgical fixation assistance for treatment of old tibial plateau fractures

目的探讨3D打印术前模拟手术固定辅助治疗胫骨平台陈旧骨折的疗效。方法对20例胫骨平台陈旧骨折患者术前采用3D打印等比例骨折模型,在模型上模拟骨折复位及固定。术后在X线片上测量胫骨平台内翻角(TPA)、股胫角(FTA)及内侧平台后倾角(PSA)评估骨折复位质量,末次随访时采用HSS膝关节功能评分评价疗效。结果患者均获得随访,时间12~26个月。骨折愈合时间4~6(5.3±0.6)个月。胫骨平台TPA、FTA及PSA末次随访时与术后即刻比较差异均无统计学意义(P>0.05)。末次随访时,患膝关节活动度:屈100°~140°(130.5°±11.9°),伸0°~5°(1.8°±1.5°);采用HSS膝关节功能评分标准评价疗效:优15例,良4例,中1例。结论3D打印术前模拟手术固定辅助治疗胫骨平台陈旧骨折,有助于制定精确的手术方案,使手术治疗更加精准及个性化;同时可增进医患沟通,节约手术时间,提高手术效率及治疗效果。

Objective To investigate the efficacy of 3D printing preoperative simulated surgical fixation assistance for treatment of old tibial plateau fractures.Methods The 20 patients with old tibial plateau fractures were treated with 3D printing equal-ratio fracture models before surgery,and simulated fracture reduction and fixation on the models.The tibial plateau varus angle(TPA),femoral tibial angle(FTA)and posterior slope angle(PSA)were measured on the postoperative X-ray film,which were used to evaluate the fracture reduction quality.HSS knee function score was used for postoperative efficacy evaluation at the last follow-up.Results All patients were followed up for 12~26 months.The fracture healing time was 4~6(5.3±0.6)months.There were no statistically significant differences in TPA,FTA,PSA between the last follow-up and immediately postoperation(P>0.05).At the last follow-up,the range of motion of the affected knee was flexion with 100°~140°(130.5°±11.9°)and extension with 0°~5°(1.8°±1.5°).The HSS knee criteria score showed that the result was excellent in 15 cases,good in 4 cases,and fair 1.Conclusions The 3D printing preoperative simulated surgical fixation assistance for treatment of old tibial plateau fractures is conducive to the formulation of accurate surgical plans,making surgical treatment more accurate and personalized;meanwhile,which can improve the communication between doctors and patients,save the operation time,and improve the operation efficiency and efficacy.