3D打印辅助微创治疗AO/OTA-43C型胫骨远端骨折早期疗效观察

Observation on the early efficacy of preoperative 3D printing combined with minimally invasive bone plate technique in the treatment of AO/OTA-43C tibial fracture

目的探讨3D打印模型辅助微创手术治疗AO/OTA-43C型胫骨远端骨折的早期疗效。方法回顾性分析2014年1月至2018年6月本科收治的AO/OTA-43C型胫骨远端骨折56例,术前3D打印模型辅助微创经皮钢板技术(3D打印微创手术组)24例,其中男14例,女10例;左侧8例,右侧16例;年龄为45~68岁,平均(54.8±5.7)岁;按AO/OTA分型:43C1型5例,43C2型15例,43C3型4例。采用常规切开复位内固定技术(ORIF组)32例,其中男17例,女15例;左侧12例,右侧20例;年龄54~71岁,平均(58.7±5.3)岁;按AO/OTA分型:43C1型7例,43C2型18例,43C3型7例。比较两组在手术切口长度、手术时间等指标和并发症方面情况。结果所有患者随访10~18个月,平均随访(13.6±2.5)个月。在手术切口长度、术中出血量、平均住院时间、术中透视次数、Johner-Wruhs功能评分优良率、骨折愈合时间等方面,3D打印组较ORIF组有明显优势,差异均有统计学意义(P<0.05)。两组均有1例并发创伤性关节炎,ORIF组1例并发切口感染。结论3D打印辅助微创接骨板技术治疗AO/OTA-43C型胫骨远端骨折创伤小、出血少、X线暴露少,早期临床疗效满意。

Objective To explore the early efficacy of preoperative 3D printing model combined with minimally invasive bone plate technique in the treatment of AO/OTA-43C tibial fracture.Methods Retrospective analysis of 56 cases of AO/OTA-43C tibial fracture admitted to our department from January 2014 to June 2018 was performed.The preoperative 3D printed model combined with minimally invasive percutaneous plate technique(3D printing minimally invasive surgery group)was conducted in 24 cases,including 14 males and 10 females;8 patients on the left and 16 patients on the right;the age ranged from 45 to 68 years,with an average of(54.8±5.7)years;AO/OTA classification:5 cases of 43C1 type,15 cases of 43C2 type,and 4 cases of 43C3 type.Thirty-two patients underwent conventional open reduction and internal fixation(ORIF group),including 17 males and 15 females;12 patients on the left and 20 patients on the right;the age ranged from 54 to 71 years,with an average of(60.7±5.3)years;AO/OTA classification:7 cases of 43C1 type,18 cases of 43C2 type,and 7 cases of 43C3 type.The surgical indexes and complications of the incision length and operation time were compared between the two groups.Results All patients were followed up for 10 to 18 months,with a mean follow-up of(13.6±2.5)months.In terms of length of incision,amount of bleeding,length of hospital stay,number of intraoperative exposures,excellent rate of Johner-Wruhs functional score,and time to fracture healing.The 3D printing group had obvious advantages compared with the ORIF group,and the difference was statistically significant(P<0.05).There were one case of traumatic arthritis in both groups and one case of incision infection in ORIF group.Conclusion Preoperative 3D printing model combined with minimally invasive bone plate technique for the treatment of AO/OTA-43C type tibial fracture has less trauma,less bleeding,less X-ray exposure,and satisfactory early clinical effect.