3D打印联合经皮微创钢板内固定术在骨盆前环损伤中的应用

Application of 3D Printing Combined With Minimally Invasive Percutaneous Plate Osteosynthesis for Anterior Pelvic Ring Injuries

目的探讨3D打印联合经皮微创钢板内固定术(minimally invasive percutaneous plate osteosynthesis,MIPPO)治疗骨盆前环损伤的初步临床效果。方法2017年12月~2023年7月我们采用3D打印联合MIPPO治疗骨盆前环损伤15例,术前3D打印建立实体模型,体外模拟手术精准预弯钢板及设计螺钉数量、方向及长度,然后沿骨盆前环骨膜下通道置入术前体外模拟手术已预弯好的内固定物,内外侧切口分别置入术前已规划好的螺钉固定。结果15例均顺利完成手术,无神经、血管损伤等并发症。手术时间(162.9±63.1)min,切口总长度(13.5±2.2)cm,术中透视次数(5.5±1.0)次,术中出血量(456.7±272.5)ml。骨折愈合时间(17.5±1.8)周。15例随访(15.2±3.9)月,Majeed功能评分由术前(18.3±2.3)分显著提高至术后6个月(86.3±6.0)分(t=-47.313,P=0.000);骨折复位Matta影像学标准:优14例,可1例,优良率93.3%(14/15)。结论3D打印联合MIPPO治疗骨盆前环损伤可取得良好的临床疗效。

Objective To investigate preliminary clinical effects of three-dimensional(3D)printing combined with minimally invasive percutaneous plate osteosynthesis(MIPPO)in the treatment of anterior pelvic ring injuries.Methods Between December 2017 and July 2023,we treated 15 patients with anterior pelvic ring injuries by using 3D printing combined with MIPPO.Before surgery,a 3D model was printed to establish the actual structure,and a steel plate was pre-bent outside the body to simulate the surgery,as well as the design of number,direction,and length of screws.Then,the pre-bent internal fixation device was inserted through the bone membrane tunnel in the anterior pelvic ring,and the screws were fixed through both sides of the incision according to the preoperative planning.Results All the 15 patients underwent surgery successfully without complications such as nerve and vascular injury.The operation time was(162.9±63.1)min,the total length of incision was(13.5±2.2)cm,the number of fluoroscopic examinations during the surgery was(5.5±1.0)times,and the amount of blood loss was(456.7±272.5)ml.The fracture healing time was(17.5±1.8)weeks.The 15 patients were followed up for(15.2±3.9)months.The Majeed functional score increased significantly from(18.3±2.3)points before surgery to(86.3±6.0)points at 6 months postoperatively(t=-47.313,P=0.000).The fracture reduction according to the Matta standards showed excellent in 14 patients,fair in one patient,the excellent and good rate being 93.3%(14/15).Conclusion Combination of 3D printing and MIPPO treatment for anterior pelvic ring injuries can achieve good clinical effects.