3D打印导航模板辅助Tönnis三联截骨术的疗效观察

3D printed navigation template assisted the completion of Tönnis triple pelvic osteotomy in developmental dysplasia of hip in older children

目的利用3D打印技术制备导航模板,探讨提高大龄儿童发育性髋关节发育不良(DDH)Tönnis三联截骨术的有效性和精确性。方法2017年12月至2018年12月南京医科大学附属儿童医院收治13例患儿,分为3D打印组(7例)和传统手术组(6例),记录两组患儿术前骨盆Sharp角,中心边缘角、手术时间、出血量及射线暴露次数,末次随访根据Mckay标准和Severin标准对治疗效果进行评价。两组患儿年龄、Sharp角、中心边缘角等计量资料行t检验,性别、髋关节发育不良侧别、Mckay和Severin评定结果等计数资料行Fisher精确概率检验。结果3D打印组和传统手术组手术时长分别为(131.63±15.68)min和(166.00±15.59)min(t=-3.989,P<0.01),出血量分别为(110.00±14.72)ml和(130.83±21.54)ml(t=-2.064,P>0.05),射线暴露次数分别为(2.29±0.49)次和(7.59±1.05)次(t=-11.809,P<0.01)。两组Mckay评价优良率分别71.4%(5/7)和83.3%[(5/6),P>0.05],Severin X线评价两组优良率均为100%(P>0.05)。结论3D打印导航模板可以辅助大龄DDH患儿Tönnis手术的完成,降低手术时间和射线暴露次数。

Objective To explore the feasibility and accuracy of Tönnis triple pelvic osteotomy for developmental dysplasia of the hip(DDH)patients by using 3D printing(3DP)technique.Methods A total of 13 DDH patients from Children’s Hospital of Nanjing Medical University from December 2017 to December 2018 were included,and divided into 3D printing group(7 cases)and traditional surgery group(6 cases).Sharp angle of the pelvis,central edge angle,operative time,blood loss and times of radiation exposure were recorded.Mckay classification and Severin classification were used to evaluate therapeutic effect.Quantitative data including age,Sharp angle,and central edge angle were compared by t-test.Qualitative data including sex,the affected side,Mckay and Severin evaluation results were assessed using Fisher’s exact test.Results In the 3DP group and the traditional surgery group,the average operation time was(131.63±15.68)min and(166.00±15.59)min(t=-3.989,P<0.01);the blood loss was(110.00±14.72)ml and(130.83±21.54)ml(t=-2.064,P>0.05);times of radiation exposure were 2.29±0.49 and 7.59±1.05(t=-11.809,P<0.01);the excellent-good rate of Mckay evaluation was 71.4%(5/7)and 83.3%[(5/6),P>0.05];the excellent-good rate of Severin X-ray evaluation was both 100%(P>0.05).Conclusion 3DP navigation template can assist the completion of Tönnis surgery in older DDH children,and reduce the operation period and the frequency of radiation exposure,which is worthy of popularization and application.