3D打印导板辅助单一前入路复位固定复杂髋臼骨折△

3D printed guider assisted open reduction and internal fixation of complex acetabular fractures through a single anterior approach

摘要:

[目的] 介绍3D 打印导板辅助单一前方入路治疗髋臼复杂骨折的手术技术和初步临床效果。[方法] 2022 年2 月—2023 年9 月对15 例髋臼复杂骨折患者在3D 打印导板辅助下经单一前入路进行治疗。术前运用E-3D 数字医疗建模设计系统软件基于患者CT 数据重建骨盆模型，经镜像处理后的骨盆模型作为模拟骨折复位后的骨盆模型，在镜像模型上设计并制作1∶1 3D 打印体内后柱导板，术中在3D 打印导板的辅助下置入后柱螺钉，并经单一前方入路复位固定髋臼复杂骨折。[结果]15 例患者均顺利完成手术，手术时间平均（103.2±11.2） min，术中无血管、神经损伤等严重并发症。术后X 线片及CT 提示髋臼前、后柱骨折均复位良好，髋臼后柱拉力螺钉位置好。随访时间6~12 个月，末次随访时骨折均愈合，改良的Merle D' Au-bigne 和Postel 评分为（16.9±1.5），临床结果优良率为86.7%。[结论] 3D 打印导板辅助经单一前方入路治疗髋臼复杂骨折，能够获得满意的复位及固定，其手术技术安全可靠。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical effect of 3D printed guider assisted open reductionand internal fixation (ORIF) of complex acetabular fractures through a single anterior approach. [Methods] From February 2022 to Septem-ber 2023, 15 patients with complex acetabular fractures were treated by abovementioned surgical procedure. Before surgery, E-3D digitalmedical modeling and design system software was used to reconstruct the pelvis model based on the patient's CT data. After image process-ing, the acetabular fractures were reduced in the pelvis model, and a 1∶1 personalized 3D printed guider for the posterior column screwplacement was designed, made and verified. In the real operation, the acetabular complex fractures were reduced and fixed under assistanceof the guider through a single anterior approach. [Results] All the 15 patients had ORIF performed successfully with the average operationtime of (103.2±11.2) min, with no vascular, nerve injury and other serious complications during the operation. Postoperative radiographsand CT indicated that the anterior and posterior column of fractured acetabulum were well reduced with the posterior column lag screwswell positioned. The follow-up time lasted from 6 months to 12 months, and the fractures were all healed at the last follow-up. The modifiedMerle D' Aubigne and Postel scores were (16.9±1.5), and excellence and good rate of the clinical outcome was of 86.7%. [Conclusion] The3D printed guider assisted ORIF of complex acetabular fractures through a single anterior approach can achieve satisfactory reduction andfixation, and is a safe and reliable surgical technique.