3D打印技术结合自制反向牵引架治疗高能量陈旧性Lisfranc损伤

Treatment of high-energy old Lisfranc injury with 3D printing technology and self-made reverse traction frame

目的 探讨3D打印技术结合自制反向牵引架治疗高能量陈旧性Lisfranc损伤的临床疗效观察。方法 回顾分析中国人民解放军第八十集团军医院2014年12月至2019年12月收治的高能量陈旧性Lisfranc损伤患者22例,所有患者入院时间均超过1个月,男12例、女10例,年龄21~49岁。术前均行CT三维重建,根据重建情况给予3D打印,明确骨折移位情况,骨折Myerson分型:B型8例、C型14例。22例患者行切开复位内固定,采用克氏针、微型钢板固定,2例关节损伤严重行关节融合术。术后按照美国足踝外科协会(American Orthopaedics Foot and Ankle Society,AOFAS)评分标准对足部功能进行疗效评定。结果 所有患者均获得长期随访,随访时间为11~24个月,平均(15.3±1.7)个月;患者完全愈合时间为9~14周,平均(11.7±2.1)周。结论 3D打印技术结合自制反向牵引架治疗高能量陈旧性Lisfranc损伤的临床效果显著,有利于明确骨折移位情况。术前制订合理的治疗计划,每个跖骨通过持续反向牵引,有利于骨折复位、软组织恢复、坚强内固定,有利于足部功能的恢复。

Objective To investigate the clinical efficacy of 3D printing technology combined with self-made reverse traction frame in the treatment of high-energy old Lisfranc injury. Methods Retrospective analysis was made on 22 patients with high-energy old Lisfranc injury admitted to the 80th Group Military Hospital of PLA from December 2014 to December 2019. All patients were hospitalized for more than 1 month, including 12 males and 10 females, aged from 21 to 49 years. All patients underwent CT three-dimensional reconstruction before operation. According to the reconstruction, 3D printing was performed to determine the displacement of fractures. Myerson classification of fractures: 8 cases of type B, 14 cases of type C. 22 patients were treated with open reduction and internal fixation, Kirschner wire and mini plate fixation, and 2 patients with severe joint injuries were treated with arthrodesis. The curative effect of foot function was evaluated according to the American Orthopaedics Foot and Ankle Society(AOFAS) score. Results All patients were followed up for 11 to 24 months with an average of(15.3±1.7) months;The total healing time of the patients ranged from 9 to 14 weeks, with an average of(11.7±2.1) weeks. Conclusion The clinical effect of 3D printing technology combined with self-made reverse traction frame in the treatment of high-energy old Lisfranc injury is significant, which is helpful to clarify the fracture displacement. A reasonable treatment plan should be made before operation. Continuous reverse traction of each metatarsal bone is conducive to fracture reduction, soft tissue recovery, strong internal fixation, and the recovery of foot function.