3D打印技术辅助骨盆髋臼骨折术中骶髂螺钉置入准确性及学习曲线的回顾性队列研究

Retrospective cohort study on the accuracy and learning curve of sacroiliac screw implantation assisted by 3D printing during pelvic acetabular fracture

目的 探究骨盆髋臼骨折术中3D打印技术辅助骶髂螺钉置入的准确性及其学习曲线。方法 选择2020年1月~2023年1月我院收治的112例骨盆髋臼骨折患者,根据是否使用3D打印技术分为常规组(56例)和3D打印组(56例),比较两组临床资料;线性回归分析单枚骶髂螺钉置入时间与手术例数的相关性,评价3D打印技术的学习曲线。结果 3D打印组的手术时间、单枚骶髂螺钉置入时间、骨折愈合时间明显短于常规组,术中出血量、围手术期输血量、导针穿刺次数、术中X线透视次数明显少于常规组,骶髂螺钉置入位置优良率、术后骨折复位优良率、髋关节功能恢复优良率明显高于常规组(P<0.05)。线性回归分析结果显示,3D打印组与常规组单枚骶髂螺钉置入时间与手术例数均呈明显负相关(r=-0.842、-0.590,P<0.001),3D打印组回归方程为单枚骶髂螺钉置入时间=69.839-4.413×手术例数,R^(2)=0.709,常规组为单枚骶髂螺钉置入时间=16.243-0.111×手术例数,R^(2)=0.348。结论 骨盆髋臼骨折手术应用3D打印技术能够显著提高骶髂螺钉置入的准确性,增加手术安全性,且随着手术例数增加,3D打印技术辅助下置钉时间明显缩短。

Objective To explore the accuracy and learning curve of sacroiliac screw implantation assisted by 3D printing technique in pelvic acetabular fracture.Methods A total of 112 patients with pelvic acetabular fractures treated in our hospital from January 2020 to January 2023 were selected and divided into a conventional group(n = 56) and a 3D printing group(n=56) according to whether 3D printing technique was used or not before operation.The clinical data of the two groups were compared.The correlation between the placement time of single sacroiliac screw and the number of surgical cases was analyzed by linear regression,and the learning curve of 3D printing technique was evaluated.Results The surgical time,insertion time of a single sacroiliac screw,and fracture healing time of the 3D printing group were significantly shorter than those of the conventional group.The intraoperative bleeding volume,perioperative blood transfusion volume,number of needle punctures,and intraoperative X-ray fluoroscopy frequency were significantly lower than those of the conventional group.The excellent and good rate of sacroiliac screw insertion position,postoperative fracture reduction,and hip joint function recovery were significantly higher than those of the conventional group(P<0.05).The results of linear regression analysis showed that there was a significant negative correlation between the insertion time of a single sacroiliac screw and the number of surgical cases in the 3D printing group and regular group(r=-0.842,-0.590,P<0.001).The regression equation of 3D printing group was insertion time of a single sacroiliac screw=69.839-4.413×Number of surgical cases,R^(2)=0.709,and that of regular group was 16.243-0.111×Number of surgical cases,R^(2)=0.348.Conclusions The application of 3D printing technology in the operation of pelvic acetabular fracture can significantly improve the accuracy of sacroiliac screw placement and increase the safety of operation,and with the increasing of the number of surgical cases,the nail placement time assisted by 3D printing technology is significantly shortened.