3D打印辅助镜下固定前交叉韧带胫骨撕脱骨折△（开放获取）

(Open Access) 3D printing assisted arthroscopic fixation of anterior cruciate ligament tibial avulsion fracture

摘要:

[目的]探讨3D打印辅助关节镜下固定前交叉韧带（anteriorcruciateligament, ACL）胫骨止点撕脱骨折的临床效果。[方法]回顾性分析2020年10月—2022年12月本院收治ACL胫骨止点撕脱骨折58例患者的临床资料，分别采用关节镜下骨折复位和经胫骨隧道牵拉高强度缝线弹性固定治疗。根据医患沟通结果，将患者分为两组，28例术前对骨折模型予以3D 打印和手术操作模拟（3D组），30例常规进行手术规划和实施（常规组）。比较两组围手术期、随访及影像资料。[结果]两组均顺利完成手术，3D组手术时间[(44.6±9.0)minvs(51.3±13.2) min, P=0.029]、术后引流量 [(163.1±29.1) ml vs (180.3±33.4) ml, P= 0.019] 和首次建立骨道成功率[例(%),17(60.7)vs10(33.3), P=0.037] 显著优于常规组。术后随访（12.7±6.9）个月，3D组恢复完全负重活动时间[(21.7±5.4) d vs (25.9±6.1) d, P=0.033] 显著早于常规组。随时间推移，两组Lysholm 评分、IKDC 评分和前抽屉试验显著改善（P＜0.05）。术后3个月时，3D组IKDC评分[(78.6±6.6)vs(74.1±7.1), P=0.016] 显著高于常规组。影像方面，3D 组骨折复位质量优良率显著高于常规组[例,优/良/差, (15/12/1)vs(8/16/6),P=0.045]。术后两组患者ACL角显著增加（P＜0.05）、 ACL 前嵴高度显著减小（P＜0.05）。术后3个月时，3D组ACL前嵴高度[(2.3±0.8)mmvs(2.9±0.8)mm,P=0.009] 显著小于常规组。[结论]关节镜下微创固定前交叉韧带胫骨止点撕脱骨折临床效果良好，3D打印辅助有助于缩短手术时间，提高建立骨道成功率和骨折复位质量，促进膝关节功能早期恢复。

Abstract:

[Objective] To investigate the clinical consequences of 3D printing assisted arthroscopic fixation of anterior cruciate ligament (ACL) tibial avulsion fracture. [Methods] A retrospective study was performed on 58 patients who received arthroscopic fracture reduction and elastic fixation with high-strength suture pulled out through tibial tunnels for ACL tibial avulsion fracture in our hospital from October 2020 to December 2022. According to preoperative doctor-patient communication, 28 patients had simulated surgical operation performed on 3D printed model before the real surgery (the 3D group), while other 30 patients had routinely arthroscopic fixation conducted without preoperative simulation (the routine group). The perioperative, follow-up and imaging data of the two groups were compared. [Results] All patients in both groups had arthroscopic fracture reduction and fixation performed smoothly. The 3D group proved significantly superior to the routine groups in terms of the operation time [(44.6±9.0) min vs (51.3±13.2) min, P=0.029], the postoperative drainage volume [(163.1±29.1) ml vs (180.3±33.4) ml, P=0.019], and the success rate of first establishment of bone tunnel [cases (%), 17 (60.7) vs 10 (33.3), P=0.037]. The follow-up period lasted for (12.7±6.9) months on an average, and the 3D group resumed full weight-bearing activities significantly earlier than that in the routine group [(21.7±5.4) days vs (25.9±6.1) days, P=0.033]. The Lysholm and IKDC scores, as well as anterior drawer test were significantly improved in both groups over time (P＜0.05). The 3D group was significantly better than the routine group regarding IKDC score 3 months after surgery [(78.6±6.6) vs (74.1±7.1), P=0.016]. With respect of imaging, the 3D group was also significantly better than the routine group in term of fracture reduction quality [excellent/good/poor, (15/12/1) vs (8/16/6), P=0.045]. The ACL angle was significantly increased (P＜0.05), while the anterior ACL crest height was significantly decreased postoperatively compared with those preoperatively in both groups (P＜0.05). The 3D group got significantly lower anterior ACL crest height than the routine group 3months postoperatively [(2.3±0.8) mm vs (2.9±0.8) mm, P=0.009]. [Conclusion] Arthroscopic reduction and fixation of ACL tibial avulsion fracture does achieve good clinical outcomes. The 3D printing assistance is helpful to shorten the operation time, improve the success rate of bone tunnel establishment and the quality of fracture reduction, and promote the early recovery of knee joint function.