3D打印辅助复杂双柱髋臼骨折术中复位的对照研究

Comparative Study of 3D Printing Assisted Intraoperative Reduction of Complex Double Column Acetabular Fractures

髋臼开放手术内固定是治疗复杂髋臼的金标准,3D 打印和三维、二维的影像比较在手术复位,手术医生学习曲线方面的价值差异比较大。方法:本研究将我院2010年1月-2020年10月78例双柱髋臼骨折患者随机分到未做3D打印(对照组)、3D打印(观察组),分析这2组病人手术时间、术中出血量、术后住院天数、术后3、6、9个月的髋关节Charnley功能评分、前后路联合手术比例等结果,重点观察3 D打印辅助术者在术前找到髋臼骨折复位的关键点,计划好复位及内固定的顺序作用。结果:(1)手术时间。2组差异有统计学意义,观察组用的手术时间更少。(2)出血量。2 组差异有统计学意义,观察组出血量更少。(3)3个月、6个月、9个月Charnley评分。观察组最高。(4)术后住院时间。2组差异有统计学意义,观察组用的手术时间更少。对照组前后联合手术的比例明显高于观察组。结论:观察组比较二维影像和三维影像组明显提高了髋臼双柱骨折手术中复位的准确性和效率,手术的预后及其他指标普遍好于后二者,具有明显的临床应用价值。

Objective:Acetabular open surgery and intermal fixation is the gold standard for the treatment of complex acetabulum.There are great diferences in the value of 3D printing and comparison of 3D and 2D images in surgical reduction and surgeon learning curve.Methods:78 patients with double column acetabular fractures in our hospital from January 2010 to October 2020 were randomly divided into two groups without 3D printing(group A)and 3D printing(group B).The results of operation time,intraoperative bleeding,postoperative hospital stay,hip Charnley function score at 3,6 and 9 months after operation and the proportion of combined anterior and posterior surgery were analyzed,Focus on observing the key points of acetabular fracture reduction found by 3D printing ssisted operators before operation,and plan the sequence of reduction and intermal fixation.Results:operation time:there was significant dfference between the two groups,and group B used less operation time.Bleeding volume:the difference between the two groups was statistically significant,and the bleeding volume in group B was less.Bleeding volume:the bleeding volume of 3D printing combined with bridging steel plate group was less than that of 3D printing combined with reconstruction steel plate group and reconstruction steel plate group.Charnley score at 3,6 and 9 months:group B was the highest.Postoperative hospital stay:the dfference between the two groups was statistically significant,and the operation time in group B was less.The proportion of combined surgery in group A was significantly higher than that in group B.Conclusion:compared with the two-dimensional image group and the three-dimensional image group,the 3D printing group significantly improves the accuracy and efficiency of reduction in the operation of acetabular double column fracture.The prognosis and other indexes of the operation are generally better than the latter two,which has obvious clinical application value.