3D打印Frosch入路胫骨后外侧平台骨折复位固定

3D printing Frosch approach for reduction and fixation of posterior lateral tibial plateau fractures

摘要:

[目的] 探讨3D打印辅助涉及胫骨后外侧平台骨折的Frosch入路显露方法及开放复位策略。 [方法] 回顾性分析2021年01月至2022年02月涉及胫骨后外侧平台骨折手术治疗患者43例。依据术前医患沟通结果，Frosch组21例采用3D打印辅助经Frosch入路切开复位内固定，前后组22例采用经前外侧联合后外侧Carlson双入路切开复位内固定。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，两组在手术时间、术口总长度、术中失血量、术中透视次数、住院时间、术口并发症和骨折复位质量比较，差异均无统计学意义（P＞0.05），Frosch组在下地行走时间比对照组早，差异有统计学意义（P＜0.05）。两组患者在术后3月、末次随访均获得满意膝关节功能，Frosch组HSS膝关节功能评分比前后组高，差异有统计学意义（P＜0.05），Frosch组膝关节屈伸活动度ROM比前后组高，差异有统计学意义（P＜0.05），前后组出现2例术口皮瓣局部缺血坏死，经换药后愈合。 [结论] 3D打印辅助涉及胫骨后外侧平台骨折Frosch入路可以直视复位，有效恢复关节面，便于内固定置入，术口并发症少，早起下地活动，功能恢复更好。

Abstract:

[Objective] Explore the Frosch approach exposure method and open reduction strategy for 3D printing assisted posterior lateral tibial plateau fractures. [Methods] Retrospective analysis of 43 patients who underwent surgical treatment for posterior lateral tibial plateau fractures from January 2021 to February 2022. According to the results of preoperative doctor-patient communication, 21 cases were treated with 3D printing assisted open reduction and internal fixation through the Frosch approach, while 22 cases were treated with conventional open reduction and internal fixation through both the anterior lateral and posterior lateral (Carlson) approaches. Compare the perioperative, follow-up, and imaging indicators between the two groups. [Results] Both groups of patients underwent surgery successfully. There was no statistically significant difference (P>0.05) between the two groups in terms of surgical time, total length of the surgical site, intraoperative blood loss, intraoperative fluoroscopy frequency, hospital stay, intraoperative complications, and fracture reduction quality. The Frosch group had earlier walking time in the ground than the around group, and the difference was statistically significant (P<0.05). Both groups of patients achieved satisfactory knee joint function at 3, 6, and 12 months after surgery. The HSS knee joint function score in the Frosch group was higher than that in the around group, and the difference was statistically significant (P<0.05),The ROM of knee joint flexion and extension activity in the Frosch group was higher than that in the around group, and the difference was statistically significant (P<0.05). while the around group experienced 2 cases of local ischemic necrosis of the surgical flap, which healed after dressing change. [Conclusion] 3D printing assistance involves the Frosch approach for tibial posterolateral plateau fractures, which can be reduced under direct vision, effectively restoring the joint surface, facilitating internal fixation placement, reducing intraoperative complications, early mobilization, and better functional recovery.