3D打印辅助开放复位内固定移位型髋臼骨折

3D printing assisted open reduction and internal fixation of displaced acetabular fractures

[目的]探讨3D打印技术在移位型髋臼骨折开放复位内固定中的应用价值。[方法]回顾性分析2018年1月—2022年06月收治的32例髋臼骨折患者的临床资料。根据医患沟通结果,16例应用3D打印技术(3D组),16例应用传统技术(传统组)。比较两组围手术期、随访及影像结果。[结果]3D组手术时间[(203.4±47.2)min vs(248.2±72.1)min,P<0.05]、切口总长度[(22.8±8.9)cm vs(31.3±12.9)cm,P<0.05]、透视次数[(7.3±1.8)次vs(12.3±3.6)次,P<0.05]、术中失血量[(587.5±401.9)ml vs(885.0±417.7)ml,P<0.05]、输血量[(132.8±154.4)ml vs(436.9±546.5)ml,P<0.05]、下地行走时间[(5.8±1.1)d vs(8.4±2.2)d,P<0.05]均显著优于传统组。随访时间平均(23.5±10.1)个月,3D组患者术后完全负重活动时间显著早于传统组[(89.1±3.8)d vs(94.6±4.9)d,P<0.05]。术后随时间推移,两组患者VAS评分、髋伸屈及内外旋ROM、Harris评分均显著改善(P<0.05)。3D组的VAS[术后1个月,(3.5±1.5)vs(5.3±1.0),P<0.05;术后6个月,(1.6±1.4)vs(3.4±1.3),P<0.05]、Harris评分[术后1个月,(56.4±5.3)vs(51.1±8.1),P<0.05;术后6个月(78.1±5.1)vs(72.8±4.8),P<0.05]均差异显著优于传统组。相应时间点两组髋伸屈及内外旋ROM和末次随访时VAS、Harris评分的差异均无统计学意义(P>0.05)。影像方面,3D组骨折复位质量显著优于传统组(P<0.05)。两组间骨折愈合时间差异无统计学意义(P>0.05)。末次随访,3D组T?nnis髋OA分级显著优于传统组(P<0.05),两组均无股骨头坏死发生。[结论]3D打印辅助治疗移位型髋臼骨折,具有手术时间短、创伤小、出血少、辐射暴露少、复位质量好、康复快、髋关节功能恢复快、并发症少的优点。

[Objective]To evaluate the value of 3D printing technology in open reduction and internal fixation(ORIF)of displaced ace⁃tabular fractures.[Methods]Clinical data of 32 patients with acetabular fracture admitted from January 2018 to June 2022 were retrospec⁃tively analyzed.According to the results of doctor-patient communication,16 patients had ORIF performed by using 3D printing simulation preoperatively(3D group),while the 16 patients received traditional ORIF(traditional group).The perioperative,follow-up and imaging consequences were compared between the two groups.[Results]The 3D group proved significantly superior to the traditional group in terms of operation time[(203.4±47.2)min vs(248.2±72.1)min,P<0.05],total incision length[(22.8±8.9)cm vs(31.3±12.9)cm,P<0.05],fluoros⁃copy times[(7.3±1.8)vs(12.3±3.6)times,P<0.05],intraoperative blood loss[(587.5±401.9)ml vs(885.0±417.7)ml,P<0.05],blood transfu⁃sion volume[(132.8±154.4)ml vs(436.9±546.5)ml,P<0.05]and ambulation time[(5.8±1.1)days vs(8.4±2.2)days,P<0.05].All patients in both groups were followed up for a mean of(23.5±10.1)months,and the 3D group resumed full weight-bearing activity significantly earlier than the traditional group[(89.1±3.8)days vs(94.6±4.9)days,P<0.05].The VAS scores,hip flexion-extension and internal-external rota⁃tion ROM,and Harris scores significantly improved over time in both groups(P<0.05).The 3D group was significantly better than the tradi⁃tional group in terms of VAS score[1 month postoperatively,(3.5±1.5)vs(5.3±1.0),P<0.05;6 months postoperatively,(1.6±1.4)vs(3.4±1.3),P<0.05],Harris score[1 month after surgery,(56.4±5.3)vs(51.1±8.1),P<0.05;6 months after surgery,(78.1±5.1)vs(72.8±4.8),P<0.05],nevertheless there were no significant differences between the two groups in hip flexion-extension and internal-external rotation ROM at any matching time points,and VAS and Harris scores at the latest follow-up(P>0.05).Regarding to imaging,the 3D group was sig⁃nificantly better than the traditional group in fracture reduction quality(P<0.05).Although there was no significant difference in fracture healing time between the two groups(P>0.05),the 3D group was significantly superior to the traditional group in Tonnis grade for hip osteo⁃arthritis at the latest follow-up(P<0.05),whereas with no femoral head necrosis in anyone in both groups.[Conclusion]3D printing assist⁃ed ORIF of displaced acetabular fractures has the advantages of shortening operation time,decreasing trauma,reducing bleeding and X-ray radiation exposure,improving reduction quality and rapid recovery of hip function with fewer complications.