3D打印联合腕关节镜全微创精准复位经皮内固定治疗累及关节面的桡骨远端骨折的效果

Effect of 3D printing combined with wrist arthroscopy,minimally invasive precision reduction and percutaneous internal fixation in the treatment of distal radius fractures involving the articular surface

目的探讨3D打印联合腕关节镜全微创精准复位经皮内固定治疗累及关节面的桡骨远端骨折的效果。方法选取2021年1月至6月顺德和平外科医院收治的30例累及关节面的桡骨远端骨折患者作为研究对象,采用随机数字表法将其分为对照组和观察组,每组15例。两组患者均统一采用经皮内固定术治疗,对照组单独采用腕关节镜全微创精准复位辅助手术,观察组采用3D打印联合腕关节镜全微创精准复位辅助手术,比较两组患者的手术耗时、术中出血量、住院时间、手术治疗费用等相关指标,观察两组手术前后的掌倾角、尺偏角、背伸角、桡偏角等腕关节活动度以及视觉模拟疼痛(VAS)评分、腕关节功能评分(GLW),记录两组患者术后关节面不平整及腕关节炎等并发症的发生情况。结果观察组的手术耗时、住院时间短于对照组,术中出血量少于对照组,手术治疗费用低于对照组,差异有统计学意义(P<0.05);观察组术后的掌倾角、尺偏角、背伸角、桡偏角均高于对照组,VAS评分、GLW评分低于对照组,差异有统计学意义(P<0.05);观察组术后的并发症发生率为13.33%(2/15),低于对照组的33.33%(5/15),差异有统计学意义(P<0.05)。结论采用3D打印联合腕关节镜全微创精准复位下的经皮内固定术治疗累及关节面的桡骨远端骨折可有效提高手术效率,降低手术对患者机体造成的损伤风险及医疗负担,此治疗方案对改善患者腕关节活动度及功能有着积极影响,同时还可减少患者术后腕关节炎及关节面不平整等并发症的发生风险,具有较高的临床推广价值。

Objective To explore the effect of 3D printing combined with wrist arthroscopy,minimally invasive precision reduction and percutaneous internal fixation in the treatment of distal radius fractures involving the articular surface.Methods A total of 30 patients with distal radius fractures involving the articular surface who were admitted to the Shunde Peace Surgery Hospital from January to June 2021 were selected as the research objects,and they were divided into the control group and the observation group using a random number table method,with 15 cases in each group.Both groups of patients were treated with percutaneous internal fixation.The control group used wrist arthroscopy with minimally invasive precision reduction surgery alone,and the observation group used 3D printing combined with wrist arthroscopy for minimally invasive precision reduction surgery.The surgery time,intraoperative blood loss,hospital stay,surgical treatment costs and other related indicators of the two groups were compared.The wrist joint mobility such as palm inclination angle,ulnar deflection angle,dorsal extension angle and radial deviation angle,visual analog score(VAS)of pain and Gart-land-Werley(GLW)of the two groups before and after surgery were observed,and the incidence of complications such as articular surface irregularities and wrist arthritis of the two groups were recorded.Results The surgery time and hospital stay of the observation group were shorter than those of the control group,the intraoperative blood loss was lower than that of the control group,the surgical treatment costs of the observation group were lower than those of the control group,the differences were statistically significant(P<0.05).The ulnar deflection angle,dorsal extension angle,and radial deflection angle of the observation group after surgery were all higher than those of the control group,and the VAS score and the GLW score of the observation group after surgery were lower than those of the control group,the differences were statistically significant(P<0.05).The incidence of postoperative complications in the observation group was 13.33%(2/15),which was lower than 33.33%(5/15)in the control group,the difference was statistically significant(P<0.05).Conclusion 3D printing combined with wrist arthroscopy,minimally invasive precision reduction and percutaneous internal fixation in the treatment of distal radius fractures involving the articular surface can effectively improve the surgery efficiency and reduce the risk of injury and medical burden caused by the surgery.This treatment scheme has a positive impact on improving the range of motion and function of the patient′s wrist,and can also reduce the risk of complications such as postoperative wrist arthritis and articular surface irregularities,it has high clinical popularization value.