3D打印技术辅助手术与传统手术治疗SchatzkerⅥ型胫骨平台骨折的多中心临床研究

3D-printing-assisted surgery versus conventional surgery for treatment of Schatzker VI tibial plateau fractures:a multi-center clinical study

目的比较3D打印技术辅助手术与传统手术治疗SchatzkerⅥ型胫骨平台骨折的疗效。方法回顾性分析2019年1月至2021年12月在南昌大学第一附属医院骨科、九江市第一人民医院骨科、萍矿总医院骨科、赣州市人民医院骨科、南昌市洪都中医院骨科收治的共50例Ⅵ型胫骨平台骨折患者资料。根据治疗方式不同分为2组:3D打印组25例(采用3D打印技术辅助手术治疗),男14例,女11例;年龄(42.5±9.1)岁;传统组25例(采用传统手术治疗),男13例,女12例;年龄(42.2±9.3)岁。记录并比较两组患者的手术时间、术中出血量、术中透视次数、骨折愈合时间和术后并发症发生情况,术后6、12个月Rasmussen放射学评分和美国特种外科医院膝关节功能评分(HSS)。结果两组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。3D打印组手术时间(125.4±10.6)min、术中出血量(206.2±16.3)mL、术中透视次数(9.2±2.7)次和骨折愈合时间(3.0±0.7)个月均显著少于传统组[(168.2±14.1)min、(303.2±20.4)mL、(15.5±3.5)次和(4.1±0.8)个月],术后6、12个月Rasmussen放射学评分(17.6±1.2)、(17.9±0.6)分和膝关节HSS评分(90.8±6.4)、(91.5±5.6)分均显著高于传统组[(16.2±2.6)、(16.7±2.2)分和(84.5±9.2)、(87.6±8.0)分],差异均有统计学意义(P<0.05)。3D打印组术后发生伤口感染1例、伤口裂开1例。传统组发生伤口处皮肤坏死2例、伤口裂开3例、创伤性关节炎1例、伤口感染2例、螺钉松动1例。3D打印组术后并发症发生率(8.0%,2/25)显著低于传统组(36.0%,9/25),差异有统计学意义(P<0.05)。结论相比传统手术治疗,3D打印技术辅助手术治疗SchatzkerⅥ型胫骨平台骨折有助于降低手术难度,减少术后并发症,促进患者骨折愈合及膝关节功能恢复,疗效更好。

Objective To compare 3D-printing-assisted surgery and conventional surgery in the treatment of Schazker typeⅥtibial plateau fractures.Methods A retrospective study was conducted to analyze the clinical data of 50 patients with typeⅥtibial plateau fracture who had been treated from January 2019 to December 2021 at the 5 Departments of Orthopedics in The First Affiliated Hospital of Nanchang University,The First People's Hospital of Jiujiang,Pingkuang General Hospital,Ganzhou People's Hospital,and Nanchang Hongdu Hospital of Traditional Chinese Medicine.The patients were divided into 2 groups according to their different treatment methods.In the 3D printing group of 25 cases treated by 3D-printing-assisted surgery,there were 14 males and 11 females,with an age of(42.5±9.1)years;in the conventional group of 25 cases treated by conventional surgery,there were 13 males and 12 females with an age of(42.2±9.3)years.The 2 groups were compared in terms of operation time,intraoperative blood loss,intraoperative fluoroscopy frequency,fracture healing time,postoperative complications,the Rasmussen radiological scores and the American Hospital for Special Surgery(HSS)knee function scores at 6 and 12 months after operation.Results There was no significant difference in the preoperative general data between the 2 groups,indicating comparability(P>0.05).The operation time[(125.4±10.6)min],intraoperative blood loss[(206.2±16.3)mL],intraoperative fluoroscopy frequency[(9.2±2.7)times]and fracture healing time[(3.0±0.7)months]in the 3D printing group were all significantly less than those in the conventional group[(168.2±14.1)min,(303.2±20.4)mL,(15.5±3.5)times and(4.1±0.8)months]while the Rasmussen radiological scores(17.6±1.2 and 17.9±0.6)and HSS knee scores(90.8±6.4 and 91.5±5.6)at 6 and 12 months after operation in the 3D printing group were all significantly higher than those in the conventional group(16.2±2.6 and 16.7±2.2;84.5±9.2 and 87.6±8.0)(all P<0.05).In the 3D printing group,there were 1 case of wound infection and 1 case of wound dehiscence after operation.In the conventional group,there were 2 cases of wound skin necrosis,3 cases of wound dehiscence,1 case of traumatic arthritis,2 cases of wound infection,and 1 case of screw loosening.The incidence of complications in the 3D printing group(8.0%,2/28)was significantly lower than that in the conventional group(36.0%,9/25)(P<0.05).Conclusion In the treatment of Schatzker type VI tibial plateau fractures,compared with conventional surgery,3D-printing-assisted surgery can lead to better curative outcomes,because it is conducive to lowering surgical difficulty,reducing postoperative complications,and promoting fracture union and functional recovery of the knee.