3D打印辅助手术对胫骨Pilon骨折患者术后功能恢复及骨代谢指标水平的影响

The effect of 3Dprinting-assisted surgery on postoperative functional recovery and bone metabolism index levels in patients with tibial Pilon fracture

目的 观察3D打印辅助手术对胫骨Pilon骨折患者术后功能恢复及骨代谢指标水平影响。方法 选取我院收治的胫骨Pilon骨折患者87例,依据治疗方案不同分为3D打印组(n=43)、常规组(n=44)。常规组行传统切开复位钢板内固定术,3D打印组行3D打印辅助下切开复位钢板内固定术。比较2组手术情况、手术满意度与术前、术后1周、1个月血清骨代谢指标[骨碱性磷酸酶(bone alkaline phosphatase, BALP)、骨钙素(osteocalcin, BGP)、抗酒石酸酸性磷酸酶5b(tartrate resistant acid phosphatase-5b, TRACP-5b)、Ⅰ型胶原羧基端肽β特殊序列(β isomer of C-terminal telopeptide of typeⅠcollagen, β-CTX)]水平,术前、术后6个月、1年踝关节功能评分(Olerud-Molander)、疼痛程度评分(visual analogue scale, VAS)。结果 3D打印组手术时间、骨折愈合时间较常规组短,透视次数、术中出血量较常规组少,差异有统计学意义(P<0.05);2组术后1周、1个月血清BALP、BGP水平较术前增高,且3D打印组高于常规组,TRACP-5b、β-CTX水平较术前降低,且3D打印组低于常规组,差异有统计学意义(P<0.05);2组术后6个月、1年Olerud-Molander评分较术前提高,且3D打印组高于常规组,VAS评分较术前下降,且3D打印组低于常规组,差异有统计学意义(P<0.05);3D打印组患者手术满意度高于常规组,差异有统计学意义(P<0.05)。结论 3D打印辅助手术治疗胫骨Pilon骨折对骨代谢不良影响小,有助于促进术后功能恢复,提高患者满意度。

Objective To observe the effect of 3D printing-assisted surgery on postoperative functional recovery and bone metabolism index levels of patients with tibial Pilon fracture.Methods In total,87 patients with tibial Pilon fracture in our hospital were selected and divided into 3D printing group(n=43) and conventional group(n=44) according to different treatment plans.The conventional group underwent traditional open reduction and internal fixation with steel plate,and the 3D printing group underwent 3D printing-assisted open reduction and internal fixation with steel plate.The surgical conditions,surgical satisfaction,serum bone metabolism indexes [bone alkaline phosphatase(BALP),osteocalcin(BGP),tartrate resistant acid phosphatase-5b(TRACP-5b),β isomer of C-terminal telopeptide of type Ⅰ collagen(β-CTX)] level before operation,at 1 week and 1 month after operation,as well as ankle function score(Olerud-Molander) and visual analogue scale(VAS) for pain before operation,at 6 months and 1 year after operation of the two groups were compared.Results The duration of operation and fracture healing time of the 3D printing group were shorter than those of the conventional group,and the number of fluoroscopy and intraoperative blood loss were less than those of the conventional group,suggesting significant differences(P<0.05).The levels of serum BALP and BGP in the two groups at 1 week and 1 month after the operation were higher than those before the operation,which were higher in the 3D printing group than in the conventional group;The levels of TRACP-5b and β-CTX were lower than those before operation,which were lower in the 3D printing group than in the conventional group,suggesting significant differences(P<0.05).The Olerud-Molander scores in the two groups at 6 months and 1 year after the operation were higher than those before the operation,which were higher in the 3D printing group than in the conventional group,while the VAS score was lower than that before the operation,which was lower in the 3D printing group than in the conventional group,suggesting significant differences(P<0.05).The surgical satisfaction of patients in the 3D printing group was higher than that in the conventional group,suggesting significant differences(P<0.05).Conclusion 3D printing-assisted surgical treatment of tibial Pilon fracture has little effect on bone metabolism,which helps to promote postoperative functional recovery and improve patient satisfaction.