3D打印导板辅助Ilizarov骨搬运技术治疗胫骨骨缺损的疗效分析

Ilizarov bone transport assisted by a 3D printed patient-specific guide plate for treatment of tibial bone defects

目的观察3D打印导板辅助Ilizarov骨搬运技术治疗胫骨骨缺损的疗效。方法回顾性分析2018年1月至2022年3月解放军第八十集团军医院全军创伤骨科研究所收治的24例胫骨骨缺损患者资料。男9例,女15例;年龄(49.8±6.5)岁。胫骨上段4例,中段缺损5例,下段缺损15例。根据骨缺损修复方式不同分为2组:3D打印组(采用3D打印个性化导板辅助Ilizarov骨搬运技术治疗,10例)和传统组(采用传统Ilizarov骨搬运技术治疗,14例)。比较两组患者手术时间、术中透视次数、术后及末次随访时胫骨轴向成角角度、外固定戴架时间(EFT)、外固定指数(EFI)。末次随访时根据Ilizarov技术研究和应用协会(ASAMI)标准评估骨缺损愈合情况,根据Paley评价标准评估功能,根据Paley的并发症分类标准记录针道感染情况。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。所有患者术后随访(11.3±2.0)个月。3D打印组患者的手术时间(19.9±2.6)min、术中透视次数(3.0±0.8)次均少于传统手术组[(38.1±2.2)min、(8.9±1.3)次];术后及末次随访时3D打印组胫骨轴向成角均显著优于传统组,差异均有统计学意义(P<0.05)。两组患者的EFT、EFI比较差异均无统计学意义(P>0.05)。末次随访时两组患者间骨愈合情况、功能结果、针道感染情况比较差异均无统计学意义(P>0.05)。结论与传统Ilizarov骨搬运技术相比,3D打印导板辅助Ilizarov骨搬运技术治疗胫骨骨缺损具有手术时间短、术中透视次数少、复位精度高的优势。

Objective To evaluate the efficacy of 3D printed patients-specific guide plates in assisting Ilizarov bone transport in the treatment of tibial bone defects.Methods A retrospective study was conducted to analyze the clinical data of 24 patients with tibial bone defects who had been admitted to Institute of Trauma Orthopedics,The 80th Army Group Hospital of PLA from January 2018 to March 2022.There were 9 males and 15 females with an age of(49.8±6.5)years,and 4 upper tibial defects,5 middle tibial defects,and 15 lower tibial defects.According to the methods of repairing bone defects,the patients were divided into 2 groups:a 3D printing group of 10 cases where a 3D printed patient-specific guide plate was used to assist Ilizarov bone transport in the treatment of tibial bone defects,and a traditional group of 14 cases where Ilizarov bone transport was performed in a traditional manner.The 2 groups were compared in terms of operation time,frequency of intraoperative fluoroscopy,axial angulation of the tibia at postoperation and the last follow-up,external fixation time(EFT)and external fixation index(EFI).At the last follow-up,healing of bone defects was evaluated according to the criteria of The Association for the Study and Application of the Method of Ilizarov(ASAMI),functional outcomes were evaluated according to the Paley criteria,and needle infection was recorded according to the Paley classification for complications.Results There was no statistically significant difference in the preoperative general data between the 2 groups,indicating comparability(P>0.05).All patients were followed up for(11.3±2.0)months on average after operation.The 3D printing group had significantly shorter operation time[(19.9±2.6)min]and significantly lower frequency of intraoperative fluoroscopy[(3.0±0.8)times]than the traditional group[(38.1±2.2)min and(8.9±1.3)times](P<0.05),and had significantly better axial angulation of the tibia at postoperation and the last follow-up than the traditional group(P<0.05).There was no significant difference in EFT or EFI between the 2 groups(P>0.05),and the last follow-up revealed no significant difference either in bone healing,functional outcomes,or needle infection between the 2 groups(P>0.05).Conclusion In the treatment of tibial bone defects,compared with conventional Ilizarov bone transport,the Ilizarov bone transport assisted by a 3D printed patient-specific guide plate demonstrates advantages of shorter operation time,lower intraoperative fluoroscopy,and higher reduction accuracy.