应用3D打印结合人工股骨头置换治疗高龄不稳定股骨转子间骨折疗效观察

Therapeutic Effect of 3D Printing Combined with Artificial Femoral Head Replacement for the Treatment of Unstable Intertrochanteric Fractures in Elderly Patients

目的评估计算机辅助设计-快速成型技术(3D打印)应用于高龄不稳定股骨转子间骨折行人工股骨头置换手术治疗的临床疗效。方法选取2016年6月～2017年6月我科收治的高龄不稳定型转子间骨折患者62例,随机分为对照组32例和实验组30例。对照组采用常规人工股骨头置换术,实验组采用3D打印辅助后实施人工股骨头置换。所有患者进行定期随访并拍摄骨盆正位X线平片,记录手术时间、出血量、术后下地时间,术后6个月、1年VAS评分及Harris评分。结果 62均例获得随访,平均随访时间(16.82±2.32)个月。1例患者术后1年因内科疾病死亡,所有患者术后切口甲级愈合,术后双下肢基本等长,相差在1 cm范围内。实验组手术时间、术后下地时间均短于对照组,实验组术中出血量少于对照组,两组比较,差异有统计学意义(P<0.05)。术后6个月、1年实验组VAS评分低于对照组,实验组Harris评分高于对照组,差异均有统计学意义(P<0.05)。结论应用3D打印结合人工股骨头置换治疗高龄不稳定股骨转子间骨折,术前3D模型便于医患沟通,利于提前做好手术计划,缩短手术时间,减少出血量,降低高龄患者手术相关并发症,改善手术疗效。

Objective To evaluate the clinical efficacy of computer-aided design-rapid prototyping(3 D printing) in the treatment of elderly patients with unstable intertrochanteric fractures undergoing artificial femoral head replacement surgery. Methods 62 patients with unstable intertrochanteric fractures admitted to our department from June 2016 to June 2017 were randomly divided into control group( n=32) and experimental group(n=30).The control group was treated with conventional artificial femoral head replacement, and the experimental group was treated with 3 D printing to perform artificial femoral head replacement. All patients underwent regular follow-up and radiographs of pelvic orthotopic radiographs. The time of surgery, the amount of bleeding, the time after surgery, the 6-month and 1-year postoperative VAS scores and Harris scores were recorded. Results62 cases were followed up, with an average follow-up time(16.82±2.32) months. One patient died of medical disease 1 year after surgery. All patients underwent grade A healing. The lower limbs were basically equal in length, with a difference of 1 cm. The operation time and postoperative time in the experimental group were shorter than those in the control group. The intraoperative blood loss in the experimental group was less than that in the control group,the difference was statistically significant(P<0.05). The VAS scores of the experimental group were lower than that of the control group,the Harris score of the experimental group was higher than that of the control group at 6 months and 1 year after operation,the differences were statistically significant(P <0.05). Conclusion 3 D printing combined with artificial femoral head replacement for the treatment of unstable intertrochanteric fractures in the elderly, the preoperative 3 D model is convenient for communication between doctors and patients, which is conducive to early surgery, shorten the operation time, reduce the amount of bleeding, and reduce the complications related to surgery in elderly patients.Improve the efficacy of surgery.