3D打印贴皮蜂窝头导板辅助骶髂螺钉植入治疗骨盆后环骨折的临床疗效

Effectiveness of sacroiliac screw implantation assisted by three-dimensional printed faceted honeycomb guide plate in treatment of posterior pelvic ring fracture

目的探讨3D打印贴皮蜂窝头导板辅助骶髂螺钉植入治疗骨盆后环骨折的临床应用效果。方法回顾分析2019年12月—2022年12月采用骶髂螺钉植入治疗的40例骨盆后环骨折患者临床资料。其中18例应用3D打印贴皮蜂窝头导板辅助骶髂螺钉植入(导板组),22例采用常规透视下徒手经皮植入骶髂螺钉(常规组)。两组患者性别、年龄、受伤至手术时间及Dennis分型等基线资料比较差异均无统计学意义(P>0.05)。记录术中每枚骶髂螺钉的植钉时间、C臂X线机透视次数、导针调整次数,术后并发症发生情况和骨愈合情况;术后6个月采用Majeed评分评价功能恢复情况;术后复查CT观察螺钉是否穿出骨皮质;于导板组矢状位CT图像上测量实际螺钉尖端、骶孔和进钉点处位置与虚拟位置之间的偏差。结果导板组S1和S2椎体分别植钉14枚和16枚,常规组分别为17枚和18枚。导板组S1、S2椎体及所有椎体每枚骶髂螺钉植钉时间、透视次数及导针调整次数均少于常规组(P<0.05)。两组患者均获随访,随访时间8~48个月,平均19.7个月。两组均未发生切口感染,无螺钉移位及内固定物松动等并发症发生。术后12周所有患者均见骨痂生长,均达骨性愈合,愈合时间12~24周,平均15.7周。导板组无患者骶髂螺钉穿破皮质;常规组2例患者骶髂螺钉穿破皮质,未损伤血管、神经。导板组实际螺钉尖端、骶孔和进钉点处位置与虚拟位置之间的偏差分别为(2.91±1.01)、(2.10±0.74)、(1.67±0.70)mm,平均偏差(2.19±1.22)mm。术后6个月两组Majeed功能评价差异无统计学意义(P>0.05)。结论3D打印贴皮蜂窝头导板技术应用于骨盆后环骨折骶髂螺钉植入能缩短螺钉植入时间、减少术中透视次数及导针调整次数,降低螺钉穿出骨皮质的风险。

Objective To investigate the effectiveness of sacroiliac screw implantation assisted by three-dimen-sional(3D)printed faceted honeycomb guide plate in the treatment of posterior pelvic ring fracture.Methods The clinical data of 40 patients with posterior pelvic ring fractures treated with sacroiliac screw implantation between December 2019 and December 2022 were retrospectively analyzed.Among them,18 cases were treated with sacroiliac screws fixation assisted by 3D printed faceted honeycomb guide plate(guide plate group),and 22 cases were treated with sacroiliac screws percutaneously fixation under fluoroscopy(conventional group).There was no significant difference in baseline data(P>0.05)such as gender,age,time from injury to operation,and Dennis classification between the two groups.The implantation time,frequency of C-arm X-ray fluoroscopy,frequency of guide pin adjustment of each sacroiliac screw,and postoperative complications and bone healing were recorded.Majeed score was used to evaluate the functional recovery at 6 months after operation,and CT was used to observe whether the screw penetrated the bone cortex.The deviation between the virtual position and the actual position of the screw tip,the sacral foramen,and the screw entry point was measured on the sagittal CT images of the guide plate group.Results The number of screws implanted in S1 and S2 vertebral bodies was 14 and 16 respectively in the guide plate group,and 17 and 18 respectively in the conventional group.The implantation time of each sacroiliac screw,the frequency of C-arm X-ray fluoroscopy,and the frequency of guide pin adjustment in S1,S2,and all vertebrae in the guide plate group were significantly less than those in the conventional group(P<0.05).Patients in both groups were followed up 8-48 months,with an average of 19.7 months.There was no incision infection,screw displacement,or internal fixation loosening in both groups.Callus growth was observed in all patients at 12 weeks after operation,and bone healing was achieved in all patients.The healing time ranged from 12 to 24 weeks,with an average of 15.7 weeks.No sacroiliac screw penetrated the bone cortex in the guide plate group;2 patients in the conventional group had sacroiliac screws penetrating the bone cortex without damaging blood vessels or nerves.In the guide plate group,the deviation between the virtual position and the actual position of the screw tip,the sacral foramen,and the screw entry point were(2.91±1.01),(2.10±0.74),and(1.67±0.70)mm,respectively,with an average deviation of(2.19±1.22)mm.There was no significant difference in Majeed function evaluation between the two groups at 6 months after operation(P>0.05).Conclusion The application of 3D printed faceted honeycomb guide plate in sacroiliac screw implantation for posterior pelvic ring fracture can shorten the screw implantation time,reduce the frequency of fluoroscopy and guide pin adjustment,and reduce the risk of screw penetration through the bone cortex.