3D打印模拟结合骨伤复原汤治疗复杂髋臼骨折△

Open reduction and internal fixation with preoperative simulation on 3D printed real model combined with Chinese herb soup for complex acetabular fractures

摘要:

［目的］评价 3D 打印模拟结合骨伤复原汤治疗复杂髋臼骨折的临床疗效。［方法］2019 年 7 月—2021 年 7 月采用开放复位内固定（open reduction and internal fixation, ORIF）治疗复杂髋臼骨折 86 例患者。依据医患沟通结果，43 例术前 3D 打印实体模型手术模拟后 ORIF，43 例采用常规 ORIF，两组均于术后口服骨伤复原汤。比较两组围术期、随访及影像学资料。［结果］ 两组患者均顺利手术，无严重并发症。3D 组手术时间、切口总长度、术中失血量、术后恢复下地行走时间、住院时间均显著优于常规组（P<0.05）；3D 组切口愈合等级亦优于常规组，但差异无统计学意义（P>0.05）。两组患者均获随访 12 个月以上， 3D 组恢复完全负重活动显著早于常规组 （P<0.05）。随术后时间推移，两组 Mere D'Aubigne 评分、髋伸屈 ROM 及髋内外旋 ROM 均显著增加，而疼痛 VAS 评分显著下降 （P<0.05）。相应时间点，3D 组的上述临床指标均显著优于常规组 （P< 0.05）。影像方面，依据 Matta 标准 3D 组术后骨折复位质量显著优于常规组 （P<0.05），3D 组影像骨折愈合时间显著早于常规组 （P<0.05），随时间推移，两组影像髋关节退变 T?nnis 评级均显著恶化 （P<0.05），术后 6 个月和末次随访时，3D 组的 T?nnis 评级优常规组，但差异无统计学意义 （P>0.05）。［结论］ 3D 打印模拟可显著提升复杂髋臼骨折开放复位内固定的效率和精准性，结合骨伤复原汤治疗有利于术后康复。

Abstract:

[Objective] To evaluate the clinical efficacy of open reduction and internal fixation (ORIF) with preoperative simulation on 3D printed real model combined with Chinese herb soup for complex acetabular fractures. [Methods] From July 2019 to July 2021, a total of 86 patients received ORIF for complex acetabular fractures. According to doctor- patient communication, 43 patients had ORIF per- formed after preoperative simulation on 3D printed real pelvic model, while the remaining 43 patients received conventional ORIF. All pa- tients in both groups were administrated with Chinese herb soup, the Gushang Fuyuan Tang, after operation. The documents regarding to perioperative period, follow-up and images were compared between the two groups. [Results] All patients in both groups had ORIF finished 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, postoperative walking time and hospital stay (P＜0.05) . In addition, the 3D group was also better than that of the conventional group in term of incision healing grade, but which was not statistically significant (P＞0.05) . All of them in both groups were followed up for more than 12 months, and the 3D group resumed full weight-bearing activity significantly earlier than the conventional group (P＜0.05) . The Mere D'Aubigne score, hip extension-flexion range of motion (ROM) and internal-external rotation ROM significantly increased, while VAS score for pain significantly decreased over time in both groups (P＜0.05) , which in the 3D group were significantly superior to the conventional group at all corresponding time points (P＜0.05) . Radiographically, the 3D group proved sig- nificantly superior to the conventional group in term of postoperative fracture reduction quality based on Matta's criteria (P＜0.05) , and frac- ture healing time on images as well (P＜0.05) . The T?nnis classification of hip degeneration deteriorated significantly over time in both groups (P＜0.05) , which in the 3D group were slightly eased compared with those in the conventional group at 6 months and the latest fol- low-up regardless of that the difference was not statistically significant (P＞0.05) . [Conclusion] This 3D printing simulation does consider-ably improve the efficiency and accuracy of ORIF for complex acetabular fractures, while the combined treatment with the Chinese herb soup is beneficial to postoperative rehabilitation.