3D打印技术结合桥接系统治疗肱骨近端骨折疗效分析

发布时间：2018-05-19 06:56

本文选题：3D打印技术 + 桥接组合式内固定系统(OBS)　；参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]肱骨近端骨折(Proximal Humeral Fracture PHF)是临床常见骨折类型,严重地影响现代人生活质量。目前,随着社会文明进程加快及现代医学的快速发展,PHF病人绝大多数都能够得到较为有效的治疗,肩关节的功能得到一定恢复,但临床治疗效果并不十分让人满意。常常出现患肢疼痛或肩关节活动功能不同程度受限等。本文通过探讨3D打印技术结合桥接组合式内固定系统(Ortho-Bridge System OBS)在治疗PHF的临床疗效,为临床治疗PHF提供一种新的思路和方法。[方法]收集昆明医科大学附属延安医院骨创伤科2014年9月-2016年06月期间收治的47例PHF病例资料。选取肱骨近端骨折Neer分型中二、三、四部分骨折病人,根据收治病人日期奇偶将病人随机分为桥接组和钢板组。桥接组总共24例,钢板组23例。术前均行CT检查及三维重建。桥接组应用3D打印技术建模,按1:1比例打印骨折及复位模型,术前在模型上应用OBS模拟手术复位及固定。手术主要采用三角肌胸大肌入路,术中复位后采用OBS植入固定骨折。钢板组使用肱骨近端锁定钢板(Looking Proximal Humerus Plate)进行固定治疗。定期复查X片及观察肩关节功能恢复情况,并应用Constant-Murley系统进行患肢功能评分。通过统计分析两组患者手术时间、出血量、骨折愈合时间、并发症发生情况、功能恢复优良率等指标分析3D打印技术结合OBS在治疗PHF临床疗效。[结果]桥接组患者骨折全部愈合,钢板组出现一例骨折延迟愈合。桥接组肩关节Constant-Murley系统评分优良率为92%,钢板组为86%。统计数据分析得出:两组平均手术切口长度、平均术中出血量(Mean bleeding volum MBV)及肩关节功能优良率方面无统计学意义。3D打印技术结合OBS治疗PHF在术后并发症、骨折愈合时间、射线暴露次数及平均手术时间(Mean operating time MOT)方面较肱骨近端锁定钢板更有优势。两组患者对肩关节功能恢复基本满意。[结论]1、固定强度:OBS在治疗PHF时,多平面的内固定方式坚强可靠,充分满足患肢早期功能锻炼要求。2、操作性:OBS结合3D打印模型,能术前完成内固定物组合配置、及塑形,操作简便。3、临床效果:OBS结合3D打印模型治疗肱骨近端骨折,疗效确切,是肱骨近端骨折手术治疗的不错选择。4、个性化及精准化:术前可根据3D骨折复位模型,利用OBS棒块组合灵活性,可为患者制定完善的手术规划、最优化及个性化精准的OBS内固定物。同时也促了进骨科临床工作向精准化、个体化方向发展。
[Abstract]:[objective] Proximal Humeral Fracture PHF) is a common fracture type of proximal humerus fracture, which seriously affects the quality of life of modern people. At present, with the acceleration of social civilization and the rapid development of modern medicine, most patients with PHF can get more effective treatment, and the function of shoulder joint can be recovered to some extent, but the effect of clinical treatment is not very satisfactory. There is often pain in the affected limbs or limited function of the shoulder joint to varying degrees. In this paper, we discuss the clinical effect of ortho-Bridge System OBSs in the treatment of PHF by using 3D printing technology combined with bridged composite internal fixation system, and provide a new way of thinking and method for clinical treatment of PHF. [methods] 47 cases of PHF were collected from the Department of Bone Trauma of Yan'an Hospital affiliated to Kunming Medical University from September 2014 to June 2016. Patients with fracture of proximal humerus were randomly divided into bridging group and plate group according to the date of treatment. There were 24 cases in bridge group and 23 cases in plate group. Ct and three-dimensional reconstruction were performed before operation. The bridge group was modeled by 3D printing technique. The fracture and reduction model was printed according to 1:1 scale. OBS was used to simulate the surgical reduction and fixation before operation. The main operation was the deltoid muscle pectoralis major approach. The fracture was fixed by OBS implantation after reduction. The proximal humerus locking Proximal Humerus Plate) was used for fixation in the plate group. X-ray examination and functional recovery of shoulder joint were observed, and Constant-Murley system was used to evaluate the function of affected limbs. The clinical efficacy of 3D printing combined with OBS in the treatment of PHF was analyzed by statistical analysis of the operation time, bleeding volume, fracture healing time, complications and the excellent and good rate of functional recovery in the two groups. [results] the fracture healed in bridge group and delayed union in plate group. The excellent and good rate of shoulder joint Constant-Murley system score in bridge group was 92 and that in steel plate group was 86. Statistical data analysis showed that there was no significant difference between the two groups in terms of average operative incision length, mean blood loss during operation and the excellent and good rate of shoulder joint function. There was no significant difference between the two groups in the treatment of postoperative complications and fracture healing time with OBS combined with 3D printing. X-ray exposure and mean operative time were superior to proximal humerus locking plate in mean operating time MOT). The patients in both groups were satisfied with the recovery of shoulder joint function. [conclusion] 1. In the treatment of PHF, the multi-plane internal fixation method is strong and reliable, which fully meets the requirement of early functional exercise of affected limb .2.The operational ratio of OBS combined with 3D printing model can complete the internal fixation combination configuration and shape before operation. The clinical effect is: OBS combined with 3D print model to treat proximal humerus fracture. It is a good choice for surgical treatment of proximal humerus fracture. The flexible combination of OBS bar and block can make perfect operation planning, optimize and personalize accurate OBS internal fixation. At the same time, it also promotes the development of orthopedic clinical work in the direction of precision and individualization.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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