3D打印导板经皮螺钉固定腕舟骨腰部骨折△ （开放获取）

3D printed guide leading percutaneous screw fixation of waist part fracture of the scaphoid (OA)

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]回顾性分析 2018 年 6 月—2021 年 6 月本院收治的 22 例腕舟骨腰部骨折患者的临床资料，根据医患沟通结果，10 例采用 3D 打印导板辅助经皮内固定术（导板组），12 例行背侧切开内固定术（常规组）。比较两组围手术期、随访及影像结果。[结果]两组患者均顺利完成手术，导板组手术时间 [(39.9±5.5) min vs (108.8±13.7) min, P＜0.001]、切口总长度 [(0.5±0.5) cm vs (5.9±0.9) cm, P＜ 0.001]、术中失血量 [(0.9±0.4) ml vs (7.8±2.0) ml, P＜0.001]、术中透视次数 [(5.4±1.2) 次 vs (13.4±3.0) 次, P＜0.001]、住院时间 [(4.8± 1.0) d vs (7.2±1.4) d, P＜0.001] 以及术后 7 d 的 VAS 评分 [(2.0±1.1) vs (3.5±1.0), P=0.003] 均显著优于常规组。随访时间 5~27 个月，导板组完全负重活动时间显著早于常规组 [(7.0±1.3) 周 vs (8.6±1.8) 周, P=0.031]。末次随访时导板组 Mayo 评分 [(95.5±5.0) vs (83.3±5.4), P＜0.001]、腕掌屈-背伸 ROM [(146.8±6.8)° vs (108.0±7.6)°, P＜0.001]、腕尺偏-桡偏 ROM [(32.0±4.4)° vs (19.9±3.1)°, P＜ 0.001]、握力 [(35.2±3.0) kg vs (29.8±5.3) kg, P=0.008] 均显著优于常规组。影像方面，两组骨折愈合时间的差异无统计学意义 （P＞0.05）。两组均无内固定装置断裂、脱出、松动情况。[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 investigate the clinical efficacy of 3D-printed guide leading palmar percutaneous screw fixation versus routine open fixation through dorsal incision for acute waist part fracture of the wrist scaphoid. [Methods] A retrospective research was done on 22 patients who received surgical fixation of scaphoid fracture at the waist part in our hospital from June 2018 to June 2021. According to the doctor-patient discussion, 10 patients underwent 3D printed guide leading percutaneous screw fixation (the guide group), while other 12 patients were treated with routine open fixation through dorsal incision (the routine group). Data of perioperative period, follow-up and images were compared between the two groups. [Results] All patients in both cohorts had operation performed successfully. The guide group proved significantly superior to the routine group in terms of operation time [(39.9±5.5) min vs (108.8±13.7) min, P＜0.001], the total incision length [(0.5±0.5) cm vs (5.9±0.9) cm, P＜0.001], intraoperative blood loss [(0.9±0.4) ml vs (7.8±2.0) ml, P＜0.001], intraoperative fluoroscopy times [(5.4±1.2) times vs (13.4±3.0) times, P＜0.001], hospital stay [(4.8±1.0) days vs (7.2±1.4) days, P＜0.001], and VAS score 7 days after surgery [(2.0±1.1) vs (3.5±1.0), P=0.003]. The follow-up period lasted for 5~27 months, and the guide group resumed full weightbearing activity significantly earlier than the routine group [(7.0±1.3) weeks vs (8.6±1.8) weeks, P=0.031]. In addition, the guide cohort was significantly better than the routine group regarding to Mayo score [(95.5±5.0) vs (83.3±5.4), P＜0.001], the wrist palmar flexion-dorsal extension range of motion (ROM) [(146.8±6.8)° vs (108.0±7.6)°, P＜0.001], the ulnar-radial deviation ROM [(32.0±4.4)° vs (19.9 ±3.1)°, P＜ 0.001], grip strength [(35.2±3.0) kg vs (29.8±5.3) kg, P=0.008] at the latest follow-up. Radiographically, there was no significant difference in fracture healing time between the two groups (P＞0.05), and no internal fixation devices broken or loosened were noted in anyone of them. [Conclusion] The 3D-printed guide leading percutaneous screw fixation of scaphoid fracture has benefits of facilitating surgical operation, better grip strength recovery and better wrist joint function recovery over the conventional open reduction and internal fixation via dorsal incision.