3D打印技术辅助手术对复杂胫骨平台骨折治疗的价值

摘要

目的 探讨3D打印技术辅助手术在复杂胫骨平台骨折治疗方面的优势及应用前景.方法 回顾性分析2014年5月至2016年9月治疗41例(48膝)复杂胫骨平台骨折患者完整资料.根据术前是否行3D打印技术分为3D打印辅助手术组和传统手术组.3D打印辅助手术组18例(22膝),男12例,女6例;年龄16～68岁,平均(45.5±7.2)岁;骨折Schatzker Ⅴ型12膝,SchatzkerⅥ型10膝.传统手术组23例(26膝),男15例,女8例;年龄19～69岁,平均(46.2±6.8)岁;骨折Schatzker Ⅴ型14膝,SchatzkerⅥ型12膝.术后对比两组单膝手术时间、术中出血量及术后6个月膝关节Rasmussen评分和纽约特种外科医院膝关节评分(hospital for special surgery knee score,HSS).结果 术后41例患者均获得随访,随访时间7～20个月,平均15个月.3D打印辅助手术组平均手术时间:Schatzker Ⅴ型(81.4±6.3)min,SchatzkerⅥ型(90.6±15.4)min;平均术中出血量:Schatzker Ⅴ型(200.4±72.3)ml,SchatzkerⅥ型(280.6±101.6)ml;术后6个月影像学Rasmussen评分:优14膝,良6膝,可2膝,优良率90.9％(20/22);HSS评分:优15膝,良5膝,可2膝,优良率90.9％(20/22).传统手术组平均手术时间:Schatzker Ⅴ型(100.4±15.3)min,SchatzkerⅥ型(111.5±20.2) min;平均术中出血量:Schatzker Ⅴ型(450.4±173.3)ml,SchatzkerⅥ型(500.5±247.2) ml;术后6个月Rasmussen评分:优14膝,良8膝,可2膝,差2膝,优良率84.6％(22/26);HSS评分:优13膝,良8膝,可2膝,差3膝,优良率80.8％(21/26).3D打印辅助手术组手术时间、术中出血量与传统手术组相比,差异有统计学意义;术后6个月Rasmussen及HSS评分与传统手术组相比,差异无统计学意义.结论 3D打印技术辅助手术治疗复杂胫骨平台骨折与传统手术相比,可以明显缩短手术时间,减少手术中出血量,但未表现出明显提高术后6个月的膝关节功能的作用.%Objective To investigate the advantage and application prospect of 3D printing technology in assisting surgery for complex tibial plateau fractures.Methods The complete clinical data of 41 patients (48 knees) were retrospectively analyzed.And these patients were divided into two groups as 3D printing assisted operation group and traditional operation group,according to whether 3D printing technology was applied.Study was carried out to compare the clinical efficacy of surgery assisted by 3D printing technology and traditional surgery in the treatment of complex tibial plateau fractures.The 3D printing assisted operation group included 18 patients (22 knees,12 males and 6 females),aging from 16 to 68 (mean age 45.5±7.2),and there were 12 cases of Schatzker Ⅴ and 10 Ⅵ.The traditional operation group included 23 patients (26 knees,15 males and 8 females),aging from 19 to 69 (mean age,46.2±6.8),and there were 14 cases of Schatzker Ⅴ and 12 Ⅵ.The operation time,intraoperative blood loss,the Rasmussen score and hospital for special surgery knee score (HSS) at 6 weeks post-operation were analyzed and the difference between the two groups was tested.Results All those patients were followed up for 7 to 20 months (mean 15 months).For 3D printing assisted operation group,the mean operation time was 81.4±6.3 min for Schatzker Ⅴ and 90.6± 15.4 min for Schatzker Ⅵ;the mean intraoperative blood loss was 200.4±72.3 ml for Schatzker Ⅴ and 280.6±101.6 ml for Schatzker Ⅵ;the result of 6-week Rasmussen score was 14 excellent,6 good and 2 fair (excellent and good rate 90.9％);the result of 6-week HSS score was 15 excellent,5 good and 2 fair (excellent and good rate 90.9％).Then for traditional operation group,the mean operation time was 100.4± 15.3 min for Schatzker Ⅴ and 111.5±20.2 min for Schatzker Ⅵ;the mean intraoperative blood loss was 450.4±173.3 ml for Schatzker Ⅴ and 500.5±247.2 ml for Schatzker Ⅵ;the result of 6-week Rasmussen score was 14 excellent,8 good,2 fair and 2 bad (excellent and good rate 84.6％);the result of 6-week HSS score was 13 excellent,8 good,2 fair and 3 bad (excellent and good rate 80.8％).The difference in operation time,intraoperative blood loss had statistical significance between the two groups;but the difference in 6-month post-operation Rasmussen score and HSS score had no statistical significance.Conclusion Compared with traditional surgery,3D printing technology assisted surgery for complex tibial plateau fracture possesses advantage such as shortened operation time,reduced intraoperative blood loss;but there's no evidence for improved knee function at 6 weeks post-operation.