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[1]鄧雄偉,萬治平,胡和軍.3D打印技術(shù)輔助經(jīng)皮撬撥復(fù)位空心釘內(nèi)固定治療跟骨骨折…[J].中醫(yī)正骨,2020,32(09):12-17.
　DENG Xiongwei,WAN Zhiping,HU Hejun.Percutaneous leverage reduction and hollow screws internal fixation assisted by 3D printing technology for treatment of calcaneus fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2020,32(09):12-17.
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3D打印技術(shù)輔助經(jīng)皮撬撥復(fù)位空心釘內(nèi)固定治療跟骨骨折…()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第32卷
期數(shù):
2020年09期
頁碼:
12-17
欄目:
臨床研究
出版日期:
2020-09-20

文章信息/Info

Title:
Percutaneous leverage reduction and hollow screws internal fixation assisted by 3D printing technology for treatment of calcaneus fractures
作者:
鄧雄偉; 萬治平; 胡和軍
(南昌市洪都中醫(yī)院,江西 南昌 330038)
Author(s):
DENG Xiongwei; WAN Zhiping; HU Hejun
Nanchang Hongdu Hospital of Traditional Chinese Medicine,Nanchang 330038,Jiangxi,China
關(guān)鍵詞:
骨折;  跟骨;  骨折固定術(shù); 內(nèi);  三維打印
Keywords:
fractures; bone;  calcaneus;  fracture fixation; internal;  3D printing
摘要:
目的:探討3D打印技術(shù)輔助經(jīng)皮撬撥復(fù)位空心釘內(nèi)固定治療跟骨骨折的臨床療效。方法:跟骨骨折患者60例,隨機分為3D打印組和常規(guī)術(shù)式組,每組30例。2組均采用經(jīng)皮撬撥復(fù)位空心釘內(nèi)固定手術(shù)治療。3D打印組,術(shù)前采用3D打印技術(shù)打印患足3D模型,詳細了解骨折情況,制定手術(shù)計劃,確定骨折復(fù)位的撬撥點和螺釘植入位置、方向、長度,并按計劃進行手術(shù)操作。常規(guī)術(shù)式組,按經(jīng)皮撬撥復(fù)位空心釘內(nèi)固定常規(guī)術(shù)式進行手術(shù)操作。記錄2組患者手術(shù)時間、術(shù)中X線透視次數(shù)及骨折愈合時間。分別于術(shù)前、術(shù)后即刻及術(shù)后6個月在X線片上測量患足B?ler角和Gissane角。術(shù)后6個月,參照Maryland足功能評分標準評價療效。結(jié)果:2組患者均順利完成手術(shù),3D打印組與常規(guī)術(shù)式組相比,手術(shù)時間短、術(shù)中透視次數(shù)少[(50.30±7.63)min,(61.47±8.29)min,t=-5.170,P=0.000;(7.03±2.02)次,(12.36±3.15)次,t=-13.493,P=0.000]。2組患者均獲隨訪,隨訪時間6～12個月,中位數(shù)10個月; 骨折均愈合,3D打印組骨折愈合時間較常規(guī)術(shù)式組短[(11.5±1.3)周,(12.5±1.5)周,t=-10.265,P=0.000]。2組患者手術(shù)前后不同時間點間患足B?ler角(3D打印組:6.28°±2.40°,29.50°±2.50°,29.30°±2.65°; 常規(guī)術(shù)式組:6.30°±2.38°,28.60°±2.48°,28.30°±2.30°)、Gissane角(3D打印組:96.30°±4.86°,132.50°±4.68°,132.44°±4.66°; 常規(guī)術(shù)式組:96.50°±4.82°,131.50°±4.60°,131.90°±4.40°)總體比較,差異均有統(tǒng)計學意義,即均存在時間效應(yīng)(F=94.404,P=0.000; F=55.860,P=0.000); 2組患者患足B?ler角、Gissane角組間總體比較,差異均無統(tǒng)計意義,即均不存在分組效應(yīng)(F=1.086,P=0.302; F=5.769,P=0.068); 時間因素和分組因素均無交互效應(yīng)(F=1.686,P=0.190; F=5.026,P=0.072)。術(shù)后6個月參照Maryland足功能評分標準評價療效,3D打印組優(yōu)13例、良12例、可3例、差2例,常規(guī)術(shù)式組優(yōu)10例、良11例、可6例、差3例; 2組患者臨床療效的組間差異無統(tǒng)計學意義(Z=-1.101,P=0.271)。結(jié)論:3D打印技術(shù)輔助經(jīng)皮撬撥復(fù)位空心釘內(nèi)固定治療跟骨骨折,與經(jīng)皮撬撥復(fù)位空心釘內(nèi)固定常規(guī)術(shù)式相比,在骨折復(fù)位和患足功能恢復(fù)方面療效相當,但術(shù)中X線透視次數(shù)少、手術(shù)時間短、骨折愈合快。
Abstract:
To explore the clinical curative effects of percutaneous leverage reduction and hollow screws internal fixation assisted by 3D printing technology for treatment of calcaneus fractures.Methods:Sixty patients with calcaneus fractures were enrolled in the study and were randomly divided into 3D printing group and conventional surgery group,30 cases in each group.All patients in the 2 groups were treated with percutaneous leverage reduction and hollow screws internal fixation.For patients in 3D printing group,the 3D models of injured feet were printed by using 3D printing technology before the surgery for detailed understanding of fractures,making surgical plan and confirming the leverage point during fracture reduction and the position,direction and length of implanted screws,and then the surgeries were performed according to the designed surgical plan.The patients in conventional surgery group were merely treated with conventional percutaneous leverage reduction and hollow screws internal fixation.The operative time,intraoperative X-ray exposure and fracture healing time were recorded and compared between the 2 groups.The B?ler angle and Gissane angle of injured foot were measured on X-ray films before the surgery,immediately after the surgery and at 6 months after the surgery respectively.The clinical curative effects were evaluated according to Maryland foot function scoring standard at 6 months after the surgery.Results:The surgeries were finished successfully in all patients.The operative time was shorter and the intraoperative X-ray exposure was fewer in 3D printing group compared to conventional surgery group(50.30+/-7.63 vs 61.47+/-8.29 min,t=-5.170,P=0.000; 7.03+/-2.02 vs 12.36+/-3.15 times,t=-13.493,P=0.000).All patients in the 2 groups were followed up for 6-12 months with a median of 10 months.All fractures healed in the 2 groups,and the fracture healing time was shorter in 3D printing group compared to conventional surgery group(11.5+/-1.3 vs 12.5+/-1.5 weeks,t=-10.265,P=0.000).There was statistical difference in B?ler angle(3D printing group:6.28+/-2.40,29.50+/-2.50,29.30+/-2.65 degrees; conventional surgery group:6.30+/-2.38,28.60+/-2.48,28.30+/-2.30 degrees)and Gissane angle(3D printing group:96.30+/-4.86,132.50+/-4.68,132.44+/-4.66 degrees; conventional surgery group:96.50+/-4.82,131.50+/-4.60,131.90+/-4.40 degrees)of injured foot between different timepoints before and after the surgery,in other words,there was time effect(F=94.404,P=0.000; F=55.860,P=0.000).There was no statistical difference in B?ler angle and Gissane angle of injured foot between the 2 groups in general,in other words,there was no group effect(F=1.086,P=0.302; F=5.769,P=0.068).There was no interaction between time factor and group factor in B?ler angle and Gissane angle of injured foot(F=1.686,P=0.190; F=5.026,P=0.072).At 6 months after the surgery,the clinical curative effects were evaluated according to Maryland foot function scoring standard.Thirteen patients obtained an excellent result,12 good,3 fair and 2 poor in 3D printing group; while 10 patients obtained an excellent result,11 good,6 fair and 3 poor in conventional surgery group.There was no statistical difference in clinical curative effects between the 2 groups(Z=-1.101,P=0.271).Conclusion:Percutaneous leverage reduction and hollow screws internal fixation assisted by 3D printing technology is similar to conventional percutaneous leverage reduction and hollow screws internal fixation in clinical curative effects on fracture reduction and injuried foot function recovery in treatment of calcaneus fractures,while the former has such advantages as fewer intraoperative X-ray exposure,shorter operative time and faster fracture healing compared to the latter.

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備注/Memo

備注/Memo:
基金項目:江西省衛(wèi)生計生委科技計劃項目(20194016); 南昌市指導(dǎo)性科技計劃項目(洪科發(fā)計字[2018]39號)
通訊作者:胡和軍 E-mail:[email protected]
更新日期/Last Update: 2020-09-20