3D打印导板经皮螺钉固定腕舟骨腰部骨折

3D printed guides for percutaneous screw fixation of scaphoid waist fractures

摘要:

目的 探讨3D打印导板辅助掌侧经皮内固定与背侧切开内固定治疗急性腕舟骨腰部骨折的临床疗效。方法 采用3D打印导板辅助经皮治疗腕舟骨腰部骨折（导板组）10例，背侧切开治疗（常规组）12例。比较两组治疗方式在手术时间、术中出血量、手术切口、疼痛评分、骨折愈合时间，随访腕关节屈伸活动度，握力以及Mayo腕关节功能评分是否存在差异。结果 导板组手术时间(39.9±5.5)min，常规组为(108.8±13.7)min；导板组切口总长度(0.5±0.5)cm，常规组为(5.9±0.9)cm；导板组术中失血量(0.9±0.4)ml，常规组为(7.8±2.0)ml；导板组透视次数(5.4±1.2)次，常规组为(13.4±3.0)次；导板组术后7天VAS评分(2.0±1.1)分，常规组为(3.5±1.0)分；导板组骨折愈合时间为（7.0±1.3）周，常规组为（8.6±1.8）周；导板组患侧腕关节屈伸活动范围（146.8±6.8）°，常规组为（108.0±7.6）°；导板组握力为（35.2±3.0）kg，常规组为（29.8±5.3）kg；导板组Mayo腕关节功能评分（95.5±5.0）分，常规组为（83.3±5.4）分，差异均具有统计学意义（P < 0.05），根据随访影像诊断骨折均愈合，但导板组愈合时间短于常规组。结论 3D打印导板辅助掌侧经皮内固定较背侧切开复位内固定治疗舟骨骨折，骨折愈合快，握力恢复好，腕关节功能恢复好。

Abstract:

Objective To explore the clinical efficacy of 3D printed guide plate assisted percutaneous palmar internal fixation and dorsal incision internal fixation in the treatment of acute scaphoid lumbar fractures. Methods There were 10 cases in the 3D printed guide plate assisted percutaneous treatment group (Guide-plate group) and 12 cases in the dorsal incision treatment group (Conventional group). Compare the treatment methods of the two groups in terms of surgical time, intraoperative blood loss, surgical incision, pain score, fracture healing time, wrist joint flexion and extension range of motion, grip strength, and Mayo wrist joint function score to see if there are any differences. Results The surgical time for the guide plate group was (39.9±5.5) minutes, while for the conventional group it was (108.8±13.7) minutes; The total length of the incision in the guide group was (0.5±0.5) cm, while in the conventional group it was (5.9±0.9) cm; The intraoperative blood loss in the guide plate group was (0.9±0.4) ml, while in the conventional group it was (7.8±2.0) ml; The fluoroscopy frequency of the guide plate group was (5.4±1.2) times, while that of the conventional group was (13.4±3.0) times; The VAS score 7 days after surgery of the guide plate group was (2.0±1.1) , while the conventional group was (3.5±1.0) ; the fracture healing time was (7.0±1.3)weeks in the Guide-plate group and (8.6±1.8) weeks in the Conventional group; the wrist flexion and extension range of motion was (108.0±7.6)° in the Guide-plate group and (146.8±6.8)° in the Conventional group. The grip strength of the Guide-plate group was (29.8±5.3) kg and that of the Conventional group was (35.2±3.0) kg. The Mayo wrist score of the Guide-plate group was (83.3±5.4) points, and that of the Conventional group was (95.5±5.0) points. The difference between the two groups was statistically significant (P < 0.05). According to follow-up imaging diagnosis, all fractures healed, but the healing time in the Guide-plate group was shorter than that in the Conventional group.. Conclusion The 3D printing guide plate assists percutaneous internal fixation in the treatment of scaphoid fractures, the fracture heals quickly, the grip strength recovers well, and the wrist joint function recovers well, which is worth trying.