3D打印导板辅助下空心螺钉内固定治疗骨盆骨折的临床研究

摘要/Abstract

摘要： 目的探讨与分析3D打印导板辅助下空心螺钉内固定治疗骨盆骨折的临床效果。方法采用前瞻性研究方法,选择2019年5月~2022年5月在格尔木市人民医院与大连理工大学附属中心医院诊治的骨盆骨折患者71例,根据随机数表法把患者分为3D打印组35例与空心螺钉组36例。空心螺钉组给予空心螺钉内固定治疗,3D打印组在空心螺钉组治疗的基础上给予3D打印导板辅助治疗,观察3D打印组与空心螺钉组患者影像学参数变化情况。结果 3D打印组与空心螺钉组的切口长度、手术时间及术中透视次数对比,差异无统计学意义（P>0.05）。3D打印组的骨折愈合时间、术中出血量显著少于空心螺钉组,差异有统计学意义（P<0.05）。3D打印组术后3个月的钉道感染、骶神经损伤、静脉血栓、切口感染等并发症发生率低于空心螺钉组,差异有统计学意义（P<0.05）。术后3个月,3D打印组与空心螺钉组骨盆入射角与骨盆倾斜角都显著小于术前1 d,差异有统计学意义（P<0.05）,3D打印组也明显小于空心螺钉组,差异有统计学意义（P<0.05）。3D打印组术后3个月的骨盆优良率显著高于空心螺钉组,差异有统计学意义（P<0.05）。结论在3D打印导板辅助下空心螺钉内固定治疗骨盆骨折能减少对患者的创伤,减少并发症的发生,促进患者骨折愈合,也能改善患者的影像学参数,提高患者的骨盆功能。

关键词: 3D打印, 空心螺钉, 骨盆骨折, 影像学参数, 并发症

Abstract: Objective Exploring and analyzing the clinical study of 3D printing guide plate-assisted internal fixation with cannulated screws in the treatment of pelvic fractures. Methods Used prospective research methods, From May 2019 to May 2022, 71 cases of patients with pelvic fractures who were diagnosed and treated in the Golmud People's Hospital were selected as the research objects, and the patients were divided into 35 cases in the 3D printing group and the cannulated screw group of 36 cases accorded to the random number table method. The cannulated screw group was given cannulated screw internal fixation treatment, and the 3D printing group was given 3D printing guide plate adjuvant therapy based on the treatment of the cannulated screw group, and the changes of imaging parameters of the two groups were observed. Results There was no significant difference in incision length, operation time and intraoperative fluoroscopy times compared between the two groups (P>; 0.05). The intraoperative blood loss and fracture healing time of the 3D printing group were significantly shorter than those of the cannulated screw group (P>; 0.05). In the 3D printing group, the incidence of complications such as pin tract infection, sacral nerve injury, venous thrombosis, and incision infection at 3 months after surgery was lower than cannulated screw group(P<; 0.05). The pelvic incident angle and pelvic inclination angle were significantly lower in both groups at 3 months after surgery than at 1 day before surgery (P<; 0.05), and the 3D printing group was also significantly lower than that in the cannulated screw group (P<; 0.05). The excellent and good rate of pelvic Majeed score 3 months after 3D printing group was significantly higher than cannulated screw group (P<; 0.05). Conclusion Internal fixation of pelvic fractures with cannulated screws assisted by 3D printing guide plate can reduce the trauma to patients, promote fracture healing, reduce the occurrence of complications, and also improve the imaging parameters of patients and improve the pelvic function of patients.

Key words: 3D printing, cannulated screw, pelvic fracture, imaging parameters, complications

中图分类号:

R683.3

尹春云, 张译文, 柳志泽. 3D打印导板辅助下空心螺钉内固定治疗骨盆骨折的临床研究[J]. 中华养生保健, 2023, 41(2): 4-8.

YIN Chun-yun, ZHANG Yi-wen, LIU Zhi-ze. Clinical Study of Internal Fixation of Pelvic Fractures with Cannulated Screws Assisted by 3D Printing Guides[J]. ZHONGHUA YANGSHENG BAOJIAN, 2023, 41(2): 4-8.

参考文献

[1] Mir R, Dragan A D, Mistry H B, et al.Sacral Insufficiency Fracture Following Pelvic Radiotherapy in Gynaecological Malignancies: Development of a Predictive Model[J]. Clin Oncol (R Coll Radiol),2021, 33(3):e101-e109.
[2] 陈华东,尚学红,赵宇,等.多层螺旋CT三维重建辅助3D打印技术对复杂髋臼骨折手术的应用价值研究[J].中国现代医学杂志,2022,32(11):20-25.
[3] 郑朋飞,王金武,庞浩田,等.3D打印导航模板辅助Tönnis三联截骨术的疗效观察[J].中华实验外科杂志,2022,39(4):767-770.
[4] 马腾,魏代好,寇涛,等.改良Galveston技术结合3D打印治疗垂直不稳定骨盆骨折的效果[J].宁夏医科大学学报,2022,44(3):286-290.
[5] 陈城,瞿钢,汤样华,等.3D打印技术辅助Salter截骨治疗发育性髋关节发育不良[J].临床骨科杂志,2022,25(1):53-57.
[6] 王金子,丁海,张衡,等.不同透视角度下髋臼杯覆盖率:评估复杂类型髋关节发育不良全髋关节置换假体的位置[J].中国组织工程研究,2022,26(3):350-353.
[7] 麦奇光,陈煜辉,朱振华,等.骨盆解锁复位架辅助复位固定治疗陈旧性DenisⅠ、Ⅱ型骶骨骨折合并骶丛损伤[J].中华骨科杂志,2022, 42(10):652-660.
[8] 张强,杜俊炜,戴志兵,等.3D打印定制半骨盆假体置换治疗原发性髋臼周围恶性肿瘤的疗效评估[J].实用骨科杂志,2022,28(3):203-208.
[9] 郭海涛,刘曙光,梅玉峰,等.改良Stoppa入路联合髂棘入路髋臼周围截骨术[J].中国矫形外科杂志,2022,30(3):264-266.
[10] 庞浩田,王亦维,范民杰,等.三维打印个体化手术导航模板在发育性髋关节发育不良手术中的应用[J].中华小儿外科杂志,2022,43(4): 365-372.
[11] 张念军,刘效仿,周观明,等.3D打印辅助全髋关节置换个体化治疗成人发育性髋关节发育不良[J].中国组织工程研究,2021,25(12): 1820-1825.
[12] 闵理,王杰,张瑀琦,等.3D打印定制一体化半骨盆假体治疗髋臼周围原发恶性骨肿瘤短期疗效的评估[J].中国骨与关节杂志,2021, 10(8):592-600.
[13] 成本强,苏晓恩,罗瑞文,等.3D打印结合腹直肌外侧入路治疗骨盆髋臼骨折疗效观察[J].实用骨科杂志,2021,27(1):10-13,26.
[14] 张晨威,费骏,曹天一,等.3D打印技术辅助置钉治疗骶髂关节结核[J].临床骨科杂志,2021,24(4):507-510.
[15] 官哲轩,严亚波,黄鲁豫,等.计算机辅助骨盆三联截骨术治疗儿童发育性髋关节脱位[J].中国矫形外科杂志,2021,29(7):649-652.
[16] 盛奇智,李广磊,刘平,等.3D打印体外建模辅助微创手术治疗Tile B型骨盆骨折的疗效观察[J].中国骨与关节损伤杂志,2021,36(12): 1275-1277.
[17] 李国梁,赵建勇.硬性标记物置入下3D打印导板辅助通道螺钉治疗骨盆骨折[J].临床骨科杂志,2021,12(5):671-677.
[18] 成本强,苏晓恩,罗瑞文.3D打印技术结合腹直肌外侧入路治疗累及四边体的髋臼骨折[J].生物骨科材料与临床研究,2021,18(5):34-38.
[19] Petryla G, Uvarovas V, Bobina R, et al.Comparison of One-Year Functional Outcomes and Quality of Life between Posterior Pelvic Ring Fixation and Combined Anterior-Posterior Pelvic Ring Fixation after Lateral Compression (B2 Type) Pelvic Fracture[J]. Medicina (Kaunas),2021,57(3):204-211.
[20] 纪振中,张奕,张明,等.3D打印骨折模型在复杂骨盆骨折手术中的治疗方法及效果探讨[J].中国医学装备,2022,19(1):111-115.