3D打印技术联合桥接组合式内固定系统治疗复杂髋臼骨折的临床疗效

Clinical efficacy of 3D printing and bridging combined internal fixation system in the treatment of complex acetabular fractures:A retrospective study

目的探讨3D打印技术联合桥接组合式内固定系统在复杂髋臼骨折中的临床应用效果。方法回顾性分析2020年3月—2022年1月北京积水潭医院贵州医院骨外科收治复杂髋臼骨折患者97例,男性51例,女性46例;年龄28~69岁,平均42.2岁;高处坠落伤28例,道路交通伤51例,挤压伤18例;合并颅脑损伤20例,胸腹脏器损伤23例,失血性休克7例,出现坐骨神经损伤症状8例,下肢深静脉血栓形成9例;骨折按Letournel-Judet分型:前柱+后半横形骨折22例,双柱骨折28例,T形骨折47例;受伤至手术时间2~14d,平均8.3d。根据手术方式不同将患者分为传统组(45例,重建钢板手术治疗)和3D组(52例,3D打印技术联合桥接组合式接骨板内固定系统治疗)。比较两组患者手术相关指标、Harris髋关节功能评分、复位情况和并发症情况。结果3D组手术时间(147.5±11.7)min、住院时间(12.5±1.0)d短于传统组(204.4±12.4)min、(14.4±1.2)d,术中透视次数(8.6±1.0)次、术后引流量(193.8±28.5)mL、术中出血量(594.7±82.6)mL少于传统组(12.4±1.4)次、(262.5±33.7)mL、(983.6±76.0)mL,差异均有统计学意义(P<0.05)。3D组术后6个月Harris髋关节功能评分各项目:功能(40.8±5.3)分、活动度(4.2±0.4)分、畸形(2.7±0.5)分、疼痛(38.4±5.0)分及总分(86.1±4.8)分高于传统组(34.7±5.8)分、(3.1±0.6)分、(2.0±0.3)分、(34.9±5.5)分、(74.7±5.8)分,差异均有统计学意义(P<0.05)。两组患者总复位满意率和并发症组间比较差异无统计学意义(P>0.05)。结论复杂髋臼骨折采用桥接组合式内固定系统联合3D打印技术治疗,可减少术中出血量,缩短手术时间,提高髋关节功能恢复效果。

Objective To explore the clinical effect of bridging combined internal fixation system(BCFS)and 3D printing in managing complex acetabular fractures.Methods From Mar.2020 to Jan.2022,97 patients with complex acetabular fractures who were admitted to the Orthopedic Department of Beijing Jishuitan Hospital Guizhou Hospital were retrospectively analyzed.There were 51 males and 46 females aged 28-69 years,mean 42.2 years.The causes of injury were falls from height in 28 cases,traffic crashes in 51,and crush injuries in 18.Among them,20 cases combined with craniocerebral injuries,23 with thoracic abdominal organ injuries,7 with hemorrhagic shock,8 with sciatic nerve injuries,and 9 with deep venous thrombosis of the lower limbs.According to Letournel-Judet classification,22 cases were of anterior column+posterior semi-transverse fracture,28 of double-column fracture,and 47 of T-shaped fracture.The time from injury to operation was 2-14 d,mean 8.3 d.Patients were divided into traditional group to receive reconstruction plate surgery(n=45)and 3D group to be fixed by 3D printing and BCFS(n=52).Operation-related indicators,Harris hip score,reduction quality and complications were compared between two groups.Results Compared with the control group,the 3D group showed much shorter operation time(min,147.5±11.7 vs.204.4±12.4)and hospital stay(d,12.5±1.0 vs.14.4±1.2),and much less frequent intraoperative fluoroscopy(times,8.6±1.0 vs.12.4±1.4),postoperative drainage volume(mL,193.8±28.5 vs.262.5±33.7)and intraoperative blood loss(mL,594.7±82.6 vs.983.6±76.0,all P<0.05).At 6 months after operation,the 3D group also revealed much better Harris hip score in separate items of function(40.8±5.3 vs.34.7±5.8),range of motion(4.2±0.4 vs.3.1±0.6),deformity(2.7±0.5 vs.2.0±0.3),pain(38.4±5.0 vs.34.9±5.5),and total score(86.1±4.8 vs.74.7±5.8,all P<0.05).Whereas the rates of satisfaction reduction and complications showed no significant difference between two groups(P>0.05).Conclusion BCFS combined with 3D printing in managing complex acetabular fractures can reduce the amount of intraoperative bleeding,shorten the operation time and improve the hip joint functional recovery.