复杂胫骨平台骨折数字和3D打印手术规划的意义△

Significance of surgical planning by digital virtual reality and 3D printing for open reduction and internal fixation of com⁃ plex tibial plateau fractures

摘要:

［目的］探讨数字虚拟现实与 3D 打印模拟手术在治疗复杂胫骨平台骨折中的临床应用价值。［方法］2018 年 6 月— 2019 年 6 月本院收治复杂胫骨平台骨折患者共 60 例，随机分为两组。30 例患者在数字虚拟现实与 3D 打印模拟手术的基础上实行开放复位内固定 （3D 组），另外 30 例采用常规技术实行手术 （常规组）。比较两组围手术期、随访与影像资料。［结果］ 两组患者均顺利完成手术。3D 组手术时间、切口长度、术中失血量、术中透视次数、钢板放置次数、术后张力性水疱发生率、住院时间方面均显著优于常规组（P<0.05）。随访时间 18~28 个月，平均（22.36±10.28）个月。3D 组下地行走时间、完全负重活动时间显著早于常规组 （P<0.05） 随术后时间推移，两组患者 VAS 评分显著降低 （P<0.05），而 HSS 评分、膝伸-屈 ROM 显著增加（P<0.05）。术后相应时间点，3D 组上述指标均显著优于常规组（P<0.05）。影像方面，3D 组骨折复位质量、术后胫骨近端内侧角、胫骨平台后倾角优于常规组（P<0.05）。［结论］数字虚拟现实与 3D 打印模拟手术可显著提升复杂胫骨平台骨折开放复位内固定的精准性，改进临床效果。

Abstract:

[Objective] To explore the value of surgical planning by digital virtual reality and 3D printing for open reduction and inter- nal fixation of complex tibial plateau fractures. [Methods] A total of 60 patients who were admitted into our hospital from June 2018 to June 2019 for complex tibial plateau fractures were randomly divided into two groups. Of them, 30 patients underwent open reduction and inter- nal fixation based on preoperative surgical planning by digital virtual reality and 3D printing, while another 30 patients underwent opera- tions by using conventional techniques. The perioperative, follow-up and imaging data were compared between the two groups. [Results] All the patients in both groups had operation completed successfully. The 3D group proved significantly superior to the conventional group in terms of operation time, incision length, intraoperative blood loss, intraoperative fluoroscopy times, plate placement times, incidence of postoperative tension blister and hospital stay (P＜0.05) . The follow- up period lasted for18~28 months, with a mean of (22.36 ± 10.28) months. The 3D group resumed walking and full weight bearing activity significantly earlier than the conventional group (P＜0.05) . The VAS scores decreased significantly (P＜0.05) , whereas the HSS score and knee extension-flexion range of motion (ROM) significantly in- creased in both groups over time postoperatively (P＜0.05) . At the corresponding postoperative time point, the 3D group was significantly su- perior to the conventional group in abovementioned items (P＜0.05) . Regarding to radiographic assessment, the 3D group got significantly better quality of fracture reduction postoperatively, and more proper medial proximal tibial angle (MPTA) and posterior tibial slope (PTS) at the latest follow up than the conventional group (P＜0.05) . [Conclusion] The digital virtual reality and 3D printing used for preoperative sur- gical planning do considerably improve the precision of open reduction and internal fixation, and improve the clinical outcome for complex tibial plateau fractures.