3D打印导板辅助复位技术联合加压克氏针系统治疗髌骨骨折

Three-dimensional Printed Guide Template-Assisted Reduction Technique Combined with Pressurized Kirschner Wire System for Patellar Fractures

目的探讨3D打印导板辅助复位技术在髌骨骨折复位中的作用,以及联合加压克氏针固定系统对髌骨骨折的疗效。方法选取30例髌骨骨折患者,按治疗方法的不同分为2组:对照组18例采用传统克氏针张力带治疗,观察组12例采用3D打印导板辅助复位技术联合加压克氏针固定系统治疗。记录并比较2组手术时间、术中出血量、术中透视次数及并发症发生率,采用纽约特种外科医院(HSS)膝关节评分(HSS评分)及视觉模拟评分法(VAS评分)评价患者膝关节功能。结果2组患者均顺利完成手术并获得随访。观察组手术时间、术中透视次数明显少于对照组(P<0.05),2组患者出血量比较,差异无统计学意义(P>0.05)。随访6~24(18.0±4.5)个月:术后3个月内X线片证实患者均获骨性愈合;对照组出现克氏针松动及皮肤激惹各1例,观察组未见并发症发生,2组并发症比较差异无统计学意义(P>0.05)。术后1周时,2组HSS及VAS评分比较差异无统计学意义(P>0.05);术后3个月、末次随访时,观察组HSS及VAS评分均优于对照组(P<0.05)。结论3D打印导板辅助复位技术联合加压克氏针固定系统能够明显提升髌骨骨折的手术复位效率与质量,并发症少,术后膝关节功能恢复较好。

Objective To explore the role of three-dimensional(3D)printed guide template-assisted technology in the reduction of patellar fractures,and to investigate the efficacy of 3D printed guide template-assisted reduction combined with Kirschner wire fixation system in the treatment of patellar fractures.Methods Thirty patients with patella fractureswere treated with traditional Kirschner wire system alone(control group,18 cases)or in combination with 3D printed guide template-assisted reduction(observation group,12 cases).The operation time,intraoperative blood loss,frequency of intraoperative fluoroscopy and incidence of complications were compared between the two groups.The knee function was evaluated by the Hospital for Special Surgery(HSS)score and the Visual Analogue Scale(VAS)score.Results Both groups successfully completed the operation and were followed upforan average of(18.0±4.5)months(range 6 to 24 months).Compared with the control group,the operation time and frequency of intraoperative fluoroscopy decreased in the observation group(P<0.05).There was no significant difference in intraoperative blood loss between the two groups(P>0.05).X-ray examination confirmed that all patients achieved bone healing within 3 months after surgery.There were 1 case of Kirschner wire loosening and 1 case of skin irritation in the control group.No complications occurred in the observation group.There was no significant difference in the incidence of complications between two groups(P>0.05).There were no significant differences in HSS and VAS scores between the two groups at 1 week after operation(P>0.05).At 3 months after surgery and at the last follow-up,both HSS and VAS scores in the observation group were superior to those in the control group(P<0.05).Conclusion The combination of 3D printed guide template-assisted reduction technology and pressurized Kirschner wire fixation system can significantly improve the efficiency and quality of surgical reduction of patellar fractures,with fewer complications and better postoperative functional recovery.