3D打印术前规划联合双反牵引装置治疗SchatzkerⅤ、Ⅵ型胫骨平台骨折

Treatment of Schatzker typeⅤandⅥtibial plateau fractures with 3D printing preoperative planning combined with double reverse traction device

背景:在SchatzkerⅤ、Ⅵ型胫骨平台骨折手术中,通过使用双反牵引装置,解决了传统手术创伤大、手术疗效不佳等问题,在临床上得到了一定程度的推广应用。3D打印技术在辅助术前评估骨折情况以及规划骨折复位内固定方案方面占有优势。目的:探讨应用3D打印术前规划联合双反牵引装置方法治疗Schatzker分型Ⅴ、Ⅵ型胫骨平台骨折的临床疗效。方法:纳入广东省中山市中医院骨三科2018年3月至2020年3月收治的Ⅴ、Ⅵ型胫骨平台骨折患者共46例,男25例,女21例,年龄19-83岁,随机分为2组。其中观察组23例采用3D打印术前规划联合双反牵引装置治疗;对照组23例行常规双反牵引微创手术治疗。比较两组手术指标数据(包括手术总操作时间、术中透视次数、术中出血量、骨折复位时间等)和临床康复指标数据(包括治疗前后患者目测类比评分、术后患肢的肿胀程度、术后并发症的发生等);随访6个月比较两组患者膝关节功能(HSS)和运动功能(FMA)评分。结果与结论:①观察组手术时长、骨折复位时间、术中出血量、术中透视次数均小于对照组(P<0.05);②观察组术后目测类比评分、肿胀程度、并发症发生率均小于对照组(P<0.05);③观察组与对照组术后第3,6个月的FMA评分和HSS膝关节功能评分均差异无显著性意义(P>0.05);④结果说明,3D打印术前规划联合双反牵引装置治疗SchatzkerⅤ、Ⅵ型胫骨平台骨折是一种安全、有效的手术方式,能够缩短手术时间和术中骨折复位时间、减少术中出血量,降低术后疼痛、肿胀程度及下肢静脉血栓等并发症发生的风险。

BACKGROUND:In the operation of Schatzker typeⅤandⅥtibial plateau fractures,the use of double reverse traction device has solved the problems of the traditional operation,such as large trauma and poor surgical effect,and has been popularized and applied in clinic to a certain extent.3D printing technology has advantages in assisting preoperative assessment of fracture and fracture reduction planning.OBJECTIVE:To investigate the clinical effect of the treatment of Schatzker typeⅤandⅥtibial plateau fractures with 3D printing preoperative planning combined with double reverse traction device.METHODS:From March 2018 to March 2020,46 patients(25 males and 21 females,aged 19-83 years)with Schatzker typeⅤandⅥtibial plateau fractures were admitted to the Department of Orthopedics,Zhongshan Chinese Medicine Hospital.All patients were assigned to two groups.Among them,23 cases in the observation group were treated with 3D printing preoperative planning combined with double reverse traction device,and 23 cases in the control group were treated with routine double reverse traction minimally invasive operation.The data of the two groups were compared,including the total operation time,the times of intraoperative fluoroscopy,the amount of intraoperative bleeding,and the time of fracture reduction,and the data of the clinical rehabilitation indexes,including the visual analogue scale scores of the patients before and after treatment,the degree of swelling of the affected limb and the occurrence of postoperative complications.Knee function(hospital for special surgery knee score)and motor function(Fugl-Meyer assessment)scores were compared between the two groups in 6-month follow-up.RESULTS AND CONCLUSION:(1)The operation time,fracture reduction time,blood loss,and fluoroscopy times were less in the observation group than those in the control group(P<0.05).(2)The postoperative visual analogue scale score,the degree of swelling,and the incidence of complications were lower in the observation group than those in the control group(P<0.05).(3)There was no significant difference in Fugl-Meyer assessment scores and hospital for special surgery knee score knee function scores between the observation group and the control group at 3 and 6 months postoperatively(P>0.05).(4)It is a safe and effective method to treat Schatzker typeⅤandⅥtibial plateau fractures with 3D printing preoperative planning combined with double reverse traction device.It can shorten the operation time and the fracture reduction time,reduce the blood loss,reduce the postoperative pain and swelling,and lower extremity venous thrombosis and other complications.