[1]邓雄伟,万治平,胡和军.3D打印技术辅助经皮撬拨复位空心钉内固定治疗跟骨骨折…[J].中医正骨,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打印技术辅助经皮撬拨复位空心钉内固定治疗跟骨骨折…()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第32卷
期数:
2020年09期
页码:
12-17
栏目:
临床研究
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:
邓雄伟; 万治平; 胡和军
(南昌市洪都中医院,江西 南昌 330038)
Author(s):
DENG Xiongwei; WAN Zhiping; HU Hejun
Nanchang Hongdu Hospital of Traditional Chinese Medicine,Nanchang 330038,Jiangxi,China
关键词:
骨折;  跟骨;  骨折固定术; 内;  三维打印
Keywords:
fractures; bone;  calcaneus;  fracture fixation; internal;  3D printing
摘要:
目的:探讨3D打印技术辅助经皮撬拨复位空心钉内固定治疗跟骨骨折的临床疗效。方法:跟骨骨折患者60例,随机分为3D打印组和常规术式组,每组30例。2组均采用经皮撬拨复位空心钉内固定手术治疗。3D打印组,术前采用3D打印技术打印患足3D模型,详细了解骨折情况,制定手术计划,确定骨折复位的撬拨点和螺钉植入位置、方向、长度,并按计划进行手术操作。常规术式组,按经皮撬拨复位空心钉内固定常规术式进行手术操作。记录2组患者手术时间、术中X线透视次数及骨折愈合时间。分别于术前、术后即刻及术后6个月在X线片上测量患足B?ler角和Gissane角。术后6个月,参照Maryland足功能评分标准评价疗效。结果:2组患者均顺利完成手术,3D打印组与常规术式组相比,手术时间短、术中透视次数少[(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组患者均获随访,随访时间6～12个月,中位数10个月; 骨折均愈合,3D打印组骨折愈合时间较常规术式组短[(11.5±1.3)周,(12.5±1.5)周,t=-10.265,P=0.000]。2组患者手术前后不同时间点间患足B?ler角(3D打印组:6.28°±2.40°,29.50°±2.50°,29.30°±2.65°; 常规术式组:6.30°±2.38°,28.60°±2.48°,28.30°±2.30°)、Gissane角(3D打印组:96.30°±4.86°,132.50°±4.68°,132.44°±4.66°; 常规术式组:96.50°±4.82°,131.50°±4.60°,131.90°±4.40°)总体比较,差异均有统计学意义,即均存在时间效应(F=94.404,P=0.000; F=55.860,P=0.000); 2组患者患足B?ler角、Gissane角组间总体比较,差异均无统计意义,即均不存在分组效应(F=1.086,P=0.302; F=5.769,P=0.068); 时间因素和分组因素均无交互效应(F=1.686,P=0.190; F=5.026,P=0.072)。术后6个月参照Maryland足功能评分标准评价疗效,3D打印组优13例、良12例、可3例、差2例,常规术式组优10例、良11例、可6例、差3例; 2组患者临床疗效的组间差异无统计学意义(Z=-1.101,P=0.271)。结论:3D打印技术辅助经皮撬拨复位空心钉内固定治疗跟骨骨折,与经皮撬拨复位空心钉内固定常规术式相比,在骨折复位和患足功能恢复方面疗效相当,但术中X线透视次数少、手术时间短、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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备注/Memo

备注/Memo:
基金项目:江西省卫生计生委科技计划项目(20194016); 南昌市指导性科技计划项目(洪科发计字[2018]39号)
通讯作者:胡和军 E-mail:397870570@qq.com
更新日期/Last Update: 2020-09-20