3D打印技术在复杂髋臼骨折手术治疗中的应用

发布时间：2018-03-02 20:20

本文选题：3D打印技术　切入点：髋臼　出处：《河南中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的探究应用3D打印技术辅助治疗复杂型髋臼骨折的临床疗效。方法回顾性分析2013年10月至2015年10月期间收治、由同一医师进行手术的的68例复杂髋臼骨折患者,其中男43例、女25例,年龄分布为24~56岁(平均36.4岁)。依Judet-Letournel分型为:双柱骨折17例,后壁+后柱骨折22例,后壁+横行骨折18例,T型骨折5例,前柱+前壁骨折6例。损伤因素:交通伤37例,坠落伤21例,建筑伤10例。合并伤:四肢骨折47例,骨盆骨折53例,颅脑损伤25例,休克18例,泌尿系损伤21例,脏器损伤11例,神经损伤8例。受伤至手术时间为2~14d(平均6.8d)。其中28例患者经螺旋CT扫描、三维快速成形术、计算机模拟及个体标本模拟手术,并根据术前计划进行手术(3D组);40例患者采取常规术前检查及手术(常规组)。运用统计学软件分析比较两组患者的切口长度、手术时间、出血量、骨折复位情况、手术并发症、后期髋关节功能恢复情况。结果本课题所有数据经严格要求搜集、审核与整理后显示:术前两组患者性别、年龄、受伤至手术时间、骨折分型、受伤原因及合并伤等一般资料无显著差异(P0.05),具有可比性。3D组患者术中出血量、手术时间、切口长度均明显低于常规组,差异具有统计学意义(P0.05)。术后一周骨折复位情况检查显示:常规组20例解剖复位、15例复位满意、5例复位不满意,满意率为87.5%,3D组23例解剖复位、4例复位满意、1例复位不满意,满意率96.4%,两组患者复位情况差异具有统计学意义(P0.05),表明3D组术后骨折复位情况明显优于常规组。所有患者均采用门诊随访、视频随访、电话随访等方式复查髋关节功能恢复及并发症情况,随访时间为6~18个月(平均12.6月),末次随访髋关节功能评分显示:常规组17例优、11例良、9例可、3例差,优良率为70.0%,3D组23例优、3例良、1例可、1例差,优良率为92.9%,两组复位情况差异具有统计学意义(P0.05),表明3D组术后髋关节功能评分明显优于常规组。并发症情况:3D组、常规组分别出现股骨头坏死0例、2例,二期均给予全髋置换术处理,创伤性关节炎2例、7例,异位骨化2例、6例,8例术前神经损伤患者末次随访时均基本恢复,两组患者术后均未出现切口感染、静脉血栓等其他并发症,两组并发症差异比较具有统计学意义(P0.05),3D组并发症发生率为14.3%,常规组并发症发生率为37.5%,与常规组相比,3D组并发症发生率明显较低。结论1.在复杂髋臼骨折治疗中应用3D打印技术,能简化手术操作步骤、缩短手术时间,减少术中创伤及失血量、提高解剖复位率、降低术后并发症发生率、改善后期关节功能,相对于传统常规手术方式具有较大优势。2.应用3D打印技术能提高复杂髋臼骨折手术治疗质量,优化复杂髋臼骨折手术治疗方案,使髋臼骨折患者在受到“一次打击”后的“二次打击”最小化,对骨科医师临床治疗具有较好的指导意义。
[Abstract]:Objective to explore the clinical efficacy of 3D printing technique in the treatment of complex acetabular fractures. Methods 68 patients with complex acetabular fractures treated by the same physician from October 2013 to October 2015 were retrospectively analyzed, including 43 males. According to Judet-Letournel classification, there were 17 cases of double column fracture, 22 cases of posterior column fracture, 18 cases of posterior wall transverse fracture, 6 cases of anterior column fracture and 6 cases of anterior column fracture. There were 21 cases of falling injury, 10 cases of building injury, 47 cases of limb fracture, 53 cases of pelvic fracture, 25 cases of craniocerebral injury, 18 cases of shock, 21 cases of urinary system injury and 11 cases of visceral injury. There were 8 cases of nerve injury. The time from injury to operation was 214d (mean 6.8 days). Among them, 28 patients underwent spiral CT scan, three-dimensional rapid angioplasty, computer simulation and individual specimen simulation surgery. According to the preoperative plan, 40 patients in the 3D group underwent routine preoperative examination and operation (routine group). The incision length, operative time, bleeding volume, fracture reduction, and surgical complications were analyzed and compared by statistical software between the two groups. Results all the data were collected, examined and sorted out: sex, age, time from injury to operation, fracture classification, and so on. There was no significant difference in general data of injury cause and complicated injury (P 0.05). The amount of intraoperative bleeding, operation time and incision length in the comparable. 3D group were significantly lower than those in the routine group. The difference was statistically significant (P 0.05). The results of reduction examination at one week after operation showed that 20 cases of anatomical reduction in routine group were satisfactory in 15 cases and satisfactory in 5 cases, and the satisfaction rate was 87.5% in 23 cases of anatomic reduction and 4 cases of satisfactory reduction in 1 case. The satisfaction rate was 96.4. The difference between the two groups was statistically significant (P 0.05), which indicated that the reduction of fracture in the 3D group was better than that in the routine group. All the patients were followed up by outpatient and video. The functional recovery and complications of hip joint were reexamined by telephone follow-up. The follow-up time was 6 ~ 18 months (mean 12.6 months). The score of hip joint function in the last follow-up group showed that 17 cases were excellent and 11 cases were good and 9 cases were good and 3 cases were poor. The excellent and good rate was 70.0%. In the 3D group, 23 cases were excellent, 3 cases were good and 1 case was good, and the excellent and good rate was 92.9%. The difference between the two groups was statistically significant (P 0.05), which indicated that the score of hip joint function in the 3D group was obviously better than that in the routine group. In the routine group, there were 0 cases of osteonecrosis of femoral head, 2 cases were treated with total hip replacement, 2 cases were traumatic arthritis, 6 cases were ectopic ossification, and 8 cases had nerve injury before operation. No incision infection, venous thrombosis and other complications were found in both groups. The difference of complications between the two groups was statistically significant. The incidence of complications in the 3D group was 14.33.The complication rate in the routine group was 37.5. Compared with the conventional group, the incidence of complications in the 3D group was significantly lower than that in the conventional group. Conclusion 1.The technique of 3D printing was used in the treatment of complex acetabular fractures. It can simplify the operation procedure, shorten the operation time, reduce the trauma and blood loss during operation, increase the rate of anatomical reduction, reduce the incidence of postoperative complications, and improve the function of joint in the later stage. Compared with the conventional operation, 3D printing technique can improve the quality of surgical treatment of complex acetabular fractures and optimize the surgical treatment of complex acetabular fractures. So that the patients with acetabular fracture can be minimized after "one strike", which has a good guiding significance for orthopedic physicians in clinical treatment.
【学位授予单位】：河南中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R687.3;TP391.73

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