摘要
背景:如何减少踝关节骨折修复的创伤、减少出血,改进操作技术、提高修复效果对临床医生提出了要求,特别是粉碎性骨折,如何在修复前制定详细的方案,多角度观察骨折的具体情况,根据二维的X射线片或者CT的平扫,建立三维立体图像,对每一位医生提出了挑战。目的:探讨3-D打印、经皮微创螺钉及锁定钢板置入内固定在踝关节骨折修复中的应用效果。方法:2012年1月至2014年6月共修复26例踝关节骨折,其中双踝关节骨折9例,三踝骨折12例,三踝骨折涉及胫骨下端PILON骨折5例。行踝关节螺旋CT扫描,以di.com格式储存,经minics软件处理,转换数据为STL格式,输入3-D打印机,制作出与踝关节骨实体1∶1大小的骨折模型,制定修复方案。出院后每月复查X射线片,观察骨折愈合情况;根据Mazur踝关节功能评分标准评定踝关节功能。结果与结论:26例均获随访,随访时间为6-12个月。所有患者骨折均愈合,骨折愈合时间4-6个月,平均5.5个月。骨折愈合良好,无血管、神经损伤、无钢板断裂。根据Mazur踝关节功能评分标准评定疗效:优11例,良13例,优良率92%。患者手术时间(64±15)min,术中出血(100±15)mL,切口均一期愈合。提示3-D打印骨折模型的模拟训练和操作对踝关节骨折患者具有损伤小、出血少、操作简单、愈合时间短、功能恢复快的优势,尤适宜粉碎性骨折。
BACKGROUND：Clinical physicians should pay attention on how to reduce ankle fracture healing wounds,reduce bleeding,improve operating technique,and improve repair effect,especially for comminuted fracture.It is necessary to understand how to develop a detailed plan before repair,observe specific circumstances of the fracture from multiple angles,and establish three-dimensional images using two-dimensional X-ray films or CT scan.These raise a challenge for each physician.OBJECTIVE：To explore the application effect of three-dimensional print,minimally invasive percutaneous screwand locking plate fixation in the repair of ankle fractures.METHODS：A total of 26 cases of fracture of ankle joint were treated from January 2012 to June 2014.There were 9cases of double ankle fracture,12 cases of three ankle fractures,and 5 cases of three ankle fractures involved PILON fracture on the lower tibia.They received spiral CT scanning on the ankle joint,and stored in the format of di.com.After processing with minics software,data were converted into STL format,and then input into the three-dimensional printer.Thus,models of ankle joint were made at the ratio of 1：1.The repair scheme was made.After discharge,X-ray films were checked every month to observe the healing condition of fractures.According to Mazur ankle score standard,ankle joint function was assessed.RESULTS AND CONCLUSION：Al 26 cases were fol owed up for 6-12 months.The fractures were healed.The healing time was 4-6 months,averagely 5.5 months.The healing was good,without vascular and nerve damage,or plate breakage.In accordance with the Mazur ankle score standard,there were excellent in 11 cases,good in 13 cases with an excel ent and good rate of 92%.The operation time was（64±15） minutes,and intraoperative blood loss was（100±15） mL.The incision was healed in stage one.These findings confirm that the simulation training and operation in fracture models of three-dimensional print have small injuries to patients with ankle fracture.The bleeding was less,the operation was simple,the healing time was short,and the functional recovery was rapid,especially for comminuted fracture.Ankle Joint; Fractures, Bone; Bone Nails; Fracture Healing; Follow-Up Studies
出处
《中国组织工程研究》
CAS
北大核心
2015年第26期4247-4252,共6页
Chinese Journal of Tissue Engineering Research
基金
克拉玛依市级科研项目(JK2014-9)~~
