筏钉技术结合3D打印治疗伴关节面塌陷的胫骨平台骨折疗效分析

发布时间：2019-02-19 16:33

【摘要】：目的探讨应用筏钉技术结合3D打印治疗伴有关节面塌陷胫骨平台骨折的临床疗效。方法回顾分析2013年9月至2015年9月,铜陵市立医院骨科收治的41例伴关节面塌陷的胫骨平台骨折患者临床资料。41例患者均采用切开复位和筏钉技术支撑塌陷关节面,并按不同的术前准备方式分为3D组(16例)和普通组(25例)。3D组患者采用3D打印技术作为术前准备,于3D模型上行术前规划及手术演练;普通组患者行常规术前准备。分别比较两组患者在手术时间、术中出血量、围手术期并发症发生率、术中骨折一次性复位成功率、术后膝关节功能评分和关节面二次塌陷率的差异。结果所有患者均获随访,随访时间9~18个月,平均11.71个月,3D组患者与普通组患者,在手术时间(80.94±18.09min和101.40±18.34min),术中出血量(77.19±24.36ml和111.60±38.64ml)、术中骨折一次性复位成功率(100%和72%)以及膝关节Rasmussen功能评分(24.88±5.32分和20.36±7.44分)的比较中,差异有统计学意义(P0.05)。3D组患者在围手术期无并发症发生,而普通组患者中有1例术中出现胫前动脉损伤,术后有1例出切口感染,并予持续换药至切口愈合;术后9个月,3D组患者和普通组患者分别有1例和4例发生关节面的二次塌陷,塌陷率分别为6.25%和16%。两组患者在围手术期并发症发生率及关节面的二次塌陷率的比较中,差异无统计学意义(P0.05)。结论筏钉技术结合3D打印治疗伴有关节面塌陷的胫骨平台骨折,可减少手术时间和术中出血量,提高术中骨折复位效率,改善术后膝关节功能。
[Abstract]:Objective to evaluate the clinical effect of rafting technique combined with 3D printing in the treatment of tibial plateau fracture with articular surface collapse. Methods from September 2013 to September 2015, 41 cases of tibial plateau fracture with articular surface collapse were retrospectively analyzed in the orthopaedic department of Tongling City Hospital. 41 patients were treated with open reduction and raft nail technique to support the collapse of the articular surface. The patients in 3D group were divided into 3D group (n = 16) and normal group (n = 25) according to different preoperative preparation methods. Patients in the general group were given routine preoperative preparation. The time of operation, the amount of intraoperative bleeding, the incidence of perioperative complications, the success rate of one-off reduction of intraoperative fracture, the score of knee joint function and the rate of secondary collapse of articular surface were compared between the two groups. Results all the patients were followed up for 9 ~ 18 months (mean 11.71 months). The operative time (80.94 卤18.09min and 101.40 卤18.34min), intraoperative bleeding volume (77.19 卤24.36ml) and intraoperative bleeding volume (111.60 卤38.64ml) in 3D group and normal group were 80.94 卤18.09min and 101.40 卤18.34min, respectively. The success rate of one-off reduction (100% vs 72%) and the Rasmussen score of knee joint (24.88 卤5.32 and 20.36 卤7.44) were compared. The difference was statistically significant (P0.05). There were no complications in the perioperative period in the 3D group, while 1 case in the common group had anterior tibial artery injury during the operation, and 1 case had wound infection after operation, and continued to change the dressing until the incision healed. 9 months after operation, 1 case in 3D group and 4 cases in normal group had secondary collapse of articular surface, the collapse rates were 6.25% and 16%, respectively. There was no significant difference in the incidence of perioperative complications and the secondary collapse rate of articular surface between the two groups (P0.05). Conclusion the treatment of tibial plateau fractures with articular surface collapse by rafting technique combined with 3D printing can reduce the operative time and blood loss, improve the reduction efficiency and improve the function of knee joint after operation.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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