3D打印辅助开放复位内固定严重鹰嘴骨折

3D printing assisted open reduction and internal fixation of severe olecranon fractures

[目的]介绍使用3D打印辅助开放复位内固定治疗严重鹰嘴骨折的手术技术和初步临床结果。[方法]利用DICOM格式术前CT数据制备1∶1骨折3D模型,进行模拟复位,确定钢板类型和放置位置,参照解剖标志和关键骨块边缘距离获得复位钉孔的空间信息,将这些空间信息再次导入软件,在软件中将复位钉孔和关键骨块的空间信息相互结合后,在软件中可以实现骨块和螺钉一起复位和还原初始位置的效果。术中依据3D打印模板进行骨折复位内固定。[结果]所有患者均顺利完成手术,无血管、神经损伤等并发症。随访时间均超过12个月,患者均获得骨性愈合,1例异位骨化,2例骨性关节炎。但是,术后12个月伤侧肘关节屈曲[(126.1±10.0)°vs(133.2±12.1)°,P=0.023]、伸直[(14.2±6.2)°vs(9.1±5.0)°,P<0.001]和肘关节活动范围[(111.1±11.2)°vs(124.0±14.1)°,P=0.001]显著不及健侧。末次随访时Mayo肘关节功能评分为(86.0±14.2)分,优良率达73.1%。[结论]3D打印辅助开放复位内固定治疗严重鹰嘴骨折,能简化操作,提升复位固定的准确性和手术效率。

[Objective]To introduce the surgical techniques and preliminary clinical results of 3D printing assisted open reduction andinternal fixation of severe olecranon fractures.[Methods]Preoperative CT data in DICOM format was used to manufacture 1:1 fracture 3Dmodel for simulated reduction,and the plate type and placement positions of the implants were determined.The spatial information of thekey screw hole was obtained by referring to anatomical markers and the edge distance of fracture fragment,and the spatial information wasre-imported into the software.Combining the spatial information of the key screw hole in the major bone pieces in the software,mimic fracture reduction and fixation were conducted to restore to the initial position.Intraoperatively,fracture reduction and internal fixation wereperformed based on the 3D printing templates.[Results]All patients had operation performed successfully without vascular and nerve injury complications.At the latest follow-up lasted for more than 12 months,all the patients got fractures healed well,one of them was of ectopic ossification,and 2 cases of osteoarthritis.However,12 months after operation,the affected side proved inferior to the healthy side interms of elbow flexion[(126.1±10.0)°vs(133.2±12.1)°,P=0.023],extesion[(14.2±6.2)°vs(9.1±5.0)°,P<0.001],and range of motion of theelbow[(111.1±11.2)°vs(124.0±14.1)°,P=0.001].The Mayo elbow performance score was of(86.0±14.2),while the excellent and good rateof clinical outcome rate was of 73.1%.[Conclusion]3D printing assisted open reduction and internal fixation for severe olecranon fracturedo simplify the operation,and improve the accuracy and efficiency of fracture reduction and fixation.