3D打印辅助Sanders III型跟骨骨折切开复位内固定△

3D printing- assisted open reduction and internal fixation of Sanders type III calcaneal fractures

摘要:

［目的］探讨 3D 打印辅助 Sanders III 型跟骨骨折切开复位内固定的临床疗效。［方法］ 回顾性分析本院 2017 年 6 月—2019 年 9 月手术治疗的 Sanders III 型跟骨骨折 80 例患者的临床资料。依据术前医患沟通结果，43 例采用 3D 打印辅助切开复位内固定术，37 例采用常规切开复位内固定术。比较两组围手术期、随访及影像指标。［结果］ 两组患者手术均顺利完成，无严重并发症。3D 组手术时间、切口总长度、术中出血量、术中透视次数、下地行走时间、切口愈合等级及住院时间均显著优于常规组 （P<0.05）。所有患者随访 （16.2±4.9） 个月。3D 组恢复完全负重活动时间显著早于常规组 （P<0.05）。 随时间推移，两组 VAS 评分均显著减少 （P<0.05），AOFAS 评分、Maryland 评分、足内-外翻 ROM 显著增加 （P<0.05）。术后相应时间点，3D 组的 VAS、AOFAS、Maryland 评分改善显著优于常规组 （P<0.05）。影像方面，术后两组跟骨宽度、跟骨高度、Gissane 角和 Bohler 角均较术前显著改善（P<0.05）。相应时间点两组上述影像指标的差异均无统计学意义（P>0.05）。［结论］ 3D 打印辅助开放复位内固定 Sanders III 型跟骨骨折，可以缩短手术时间，减少出血量，促进功能恢复，降低并发症发生率。

Abstract:

[Objective] To investigate the clinical efficacy of 3D printing-assisted open reduction and internal fixation (ORIF) of Sand- ers type III calcaneal fractures. [Methods] A retrospective study was performed on 80 patients who underwent ORIF for Sanders type III cal- caneal fractures in our hospital from June 2017 to September 2019. According to preoperative doctor-patient communication, 43 patients were treated with 3D printing assisted ORIF, while the remaining 37 patients were with conventional ORIF. The perioperative, follow-up and imaging data were compared between the two groups. [Results] All the patients in both groups had operation completed successfully without serious complications. The 3D group proved significantly superior to the conventional group in terms of operation time, total incision length, intraoperative blood loss, intraoperative fluoroscopy times, postoperative ambulation, incision healing grade and hospital stay (P＜0.05) . All patients were followed up for (16.2±4.9) months on an average, and the 3D group resumed full weight-bearing activity significantly earlier than the conventional group (P＜0.05) . The VAS scores decreased significantly (P＜0.05) , while the AOFAS score, Maryland score and foot varus- valgus range of motion (ROM ) increased significantly in both groups over time postoperatively (P＜0.05) , which in the 3D group proved significantly superior to the conventional group at all corresponding time point after surgery (P＜0.05) . With regard to imaging, the calcaneal width, calcaneal height, Gissane angle and Bohler angle significantly improved in both groups after operation compared with those before operation (P＜0.05) , whereas which were of no significant difference between the two groups at any corresponding time points (P＞ 0.05) . [Conclusion] 3D printing-assisted open reduction and internal fixation of Sanders type III calcaneal fractures does shorten the opera- tion time, reduce the amount of blood loss, promote functional recovery and reduce complications.