3D打印技术结合标志定位法在胫骨远端A型骨折中的临床应用*

目的探讨3D打印技术结合标志定位法在胫骨远端A型骨折中的临床应用价值。方法回顾性分析武汉科技大学附属普仁医院骨科2019 年1 月至2021 年2 月收治的共62 例胫骨远端A型骨折患者资料，患者被分为两组，3D打印技术结合标志定位法组（31例）采用3D打印技术结合标志定位法+微创内固定手术方式，传统组（31例）常规采用微创内固定手术方式。两组均在骨折断端有限切开进行复位，收集两组患者的手术时间、透视次数、术中失血量、AOFAS功能评分、钢板放置位置等数据。结果两组术中均达到解剖复位，通过对两组数据比较分析，术后6个月AOFAS评分比较差异无统计学意义（P＞0.05）。与传统组钢板放置角度（3.84±1.93）°、距离（2.19±1.42）mm相比，3D打印技术结合标志定位法组钢板放置角度为（2.87±1.09）°、距离（1.52±0.93）mm，差异具有统计学意义（P＜0.05）。在手术时间、透视次数、术中失血量方面，3D打印技术结合标志定位法组（76.03±3.65）min、（3.23±0.76）次、（71.29±7.30）mL均少于传统组（79.74±6.92）min、（3.81±0.91）次、（76.29±9.31）mL，差异具有统计学意义（P＜0.05）。结论 3D打印技术结合标志定位法在胫骨远端A型骨折手术中的应用有效缩短了手术时间、减少了透视次数和失血量，使钢板放置位置更加贴近胫骨力线，标志定位法为3D打印技术在胫骨远端A型骨折术前计划的准确实施提供了新思路。

英文摘要:

Objective To explore the clinical application value of 3D printing technology combined with landmark positioning method in distal tibia type A fractures. Methods The data of 62 patients with type A fractures of the distal tibia admitted to the Puren Hospital Affiliated to Wuhan University of Science and Technology from January 2019 to February 2021 were retrospectively analyzed. The patients were divided into two groups: 3D printing technology combined with landmark positioning method and minimally invasive group (31 cases) used 3D printing technology combined with landmark positioning method and minimally invasive internal fixation; and the traditional minimally invasive group (31 cases) used conventional minimally invasive internal fixation. All patients were treated by limited open reduction, and the operation time, fluoroscopy times, intraoperative blood loss, AOFAS functional score, plate placement and other data of the two groups were collected. Results All of the 62 cases got total anatomical reduction after the operation. By comparing and analyzing the data of the two groups, there was no significant difference in the AOFAS score at 6 months after operation (P>0.05). Compared with the plate placement angle (3.84±1.93)° and the distance (2.19±1.42) mm in the traditional minimally invasive group, in the 3D printing technology combined with landmark positioning method and minimally invasive group, the steel plate placement angle was (2.87±1.09)° and the distance was (1.52±0.93) mm, and the difference was statistically significant (P<0.05). Comparing the operation time, fluoroscopy times, and intraoperative blood loss, the 3D printing technology combined with landmark positioning method and minimally invasive group had (76.03±3.65) min, (3.23±0.76) times, and (71.29±7.30) mL, all of which were less than traditional minimally invasive group, respectively (79.74±6.92) min, (3.81±0.91) times, (76.29±9.31) mL, and the difference was statistically significant (P<0.05). Conclusion The application of 3D printing technology combined with landmark positioning method in the operation of distal tibial type A fracture effectively shortens the operation time, reduces the number of fluoroscopy and blood loss, and makes the placement of the plate closer to the tibial force line. The landmark positioning method provides a new idea for the accurate implementation of 3D printing technology in the preoperative planning of distal tibia type A fractures.

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