3D打印Frosch入路胫骨后外侧平台骨折复位固定△（开放获取）

3D printing assistance and Frosch approach for open reduction and internal fixation of posterolateral 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与结果。[方法] 回顾性分析2021 年1 月—2022 年2 月本院手术治疗的43 例胫骨后外侧平台骨折患者。依据术前医患沟通结果，21 例采用3D 打印辅助经Frosch 入路切开复位内固定（Frosch 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（前后组）。比较两组围手术期、随访及影像指标。[结果] 两组患者均顺利完成手术，两组手术时间、切口总长度、术中失血量、术中透视次数、住院时间的差异均无统计学意义（P＞0.05），但Frosch 组下地行走时间显著早于前后组[(8.4±0.3) d vs (14.5±0.3) d, P＜0.001]。与术后3 个月相比，末次随访时，两组患者膝痛VAS 评分、HSS 评分、膝伸屈ROM 均显著改善（P＜0.05），相应时间点，Frosch 组膝痛VAS 评分[术后3 个月, (2.2±1.1) vs (3.9±1.7), P=0.039; 末次随访, (0.9±0.7) vs (1.8±1.4), P＜0.001]、HSS 评分[术后3 个月, (62.5±6.2) vs (58.1±6.3), P=0.026; 末次随访, (88.8±7.5) vs (81.6±9.2), P=0.007]、膝伸屈ROM [术后3 个月, (91.7±3.2)° vs(87.6±3.8)°, P＜0.001; 末次随访, (120.6±4.3)° vs (116.9±3.5)°, P=0.003] 均显著优于前后组。[结论] 3D 打印辅助联合Frosch 入路可以直视复位胫骨后外侧平台骨折，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] To explore the strategy and outcome of 3D printing assistance and Frosch approach for open reduction and in-ternal fixation (ORIF) of posterolateral tibial plateau fractures. [Methods] A retrospective study was performed on 43 patients who receivedORIF for posterolateral tibial plateau fractures in our hospital from January 2021 to February 2022. According to the preoperative doctorpatientcommunication, 21 patients were treated with ORIF of 3D printing assistance and Frosch approach (Frosch group), while the re-mained 22 patients received ORIF via the anterolateral combined posterolateral Carlson approach (AP groups). The documents regarding toperioperative period, follow-up and images were compared between the two groups. [Results] All patients in both groups had correspondingsurgical procedures performed successfully, without significant differences in terms of operation time, total incision length, intraoperativeblood loss, intraoperative fluoroscopy times, hospital stay between the two groups (P＞0.05). However, the Frosch group resumed walking sig-nificantly earlier than the AP group [(8.4±0.3) days vs (14.5±0.3) days, P＜0.001]. Compared with those 3 months after surgery, the VASscore for knee pain, HSS score and knee extension-flexion ROM were significantly improved in both groups at the last follow-up (P＜0.05).The Frosch group proved significantly superior to the AP group in terms of VAS [(2.2±1.1) vs (3.9±1.7), P=0.039] 3 months after surgery,[(0.9±0.7) vs (1.8±1.4), P＜0.001] at the last follow-up; HSS score [(62.5±6.2) vs (58.1±6.3), P=0.026] 3 months postoperatively, [(88.8±7.5)vs (81.6±9.2), P=0.007] at the latest follow-up; the knee ROM [(91.7±3.2)° vs (87.6±3.8)°, P＜0.001] 3 months postoperatively, [(120.6±4.3)° vs (116.9±3.5)°, P=0.003] at the final interview. [Conclusion] The 3D printing assistance combined with Frosch approach can explorethe posterolateral tibial plateau fracture directly to facilitate effective reduction of the articular surface and placement of internal fixation im-plants, reduce operative complications, regain ambulation early, and achieve better functional recovery.