摘要
目的探讨3D打印接力截骨导板在踝关节内骨折畸形愈合矫正治疗中的应用价值。方法回顾性分析2013年10月至2015年10月采用3D打印接力截骨导板辅助治疗的14例严重踝关节内骨折畸形愈合患者资料。男10例，女4例；平均年龄40．5岁（34～59岁）。所有患者患踝术前行薄层CT扫描，获得胫腓骨远端的定位及截骨导板的计算机虚拟模型，3D打印出与实体骨骼尺寸一致的定位及截骨导板，在截骨导板引导下完整截除畸形愈合骨块，复位固定骨折。记录骨折愈合时间及末次随访时疼痛视觉模拟评分（VAS）、美国足踝外科协会（AOFAS）踝．后足评分、36项健康调查简表（SF-36）评分、踝关节活动度及并发症发生情况等。结果14例患者术后获平均28．6个月（14—35个月）随访。骨性愈合时间平均为3．7个月（3～6个月）。末次随访时VAS评分[（2．2±0．8）分]、AOFAS踝．后足评分[（81．1±6．8）分]、SF-36评分[（82．5±5．2）分]及背伸活动度（27．5°±2．5°）、跖屈活动度（24．2°±6．3°）均较术前[（6．3±1．8）分、（43．1±12．0）分、（37．6±9．9）分、14．1°±3．8°、14．4°±3．9°]显著改善，差异有统计学意义（P〈0．05）。随访期间未出现内固定失效或创伤性关节炎。结论采用3D打印接力截骨导板技术可以通过微创便捷地对踝关节内畸形愈合的不规则骨折线实行精确定位、精准截骨，实现真正意义上的解剖复位，为创伤性关节炎的防治提供新的技术手段。
Objective To explore the effectiveness of our self-designed 3D printing relay template in the treatment of malunion of irregular intra-articular ankle fractures. Methods From October 2013 to October 2015, our self-designed 3D printing relay template was used in 14 patients with severe malunion of intra-articular ankle fracture to assist their intra-artieular osteotomy. They were 10 males and 4 females, with an average age of 40.5 years （from 34 to 59 years）. Thin slice CT scan was preformed preoperatively for all the ankles involved. The computer fictitious tibial and fibular models for location and osteotomy navigation templates were acquired from the data of CT scan after processing, design and reconstruction by software. After the navigation templates which fit the size of solid ankle were printed by a 3D printer, they were sterilized and reserved. The guide plates were used in turn during operation. The irregular malunited bone blocks in the posterior malleolus were completely resected along the osteotomy template. After fracture reduction, the bone blocks were stabilized with internal fixation. Fracture union time was recorded. Scores of visual analogue scale （VAS）, American Orthopaedic Foot and Ankle Society （AOFAS） and the short form-36 （SF-36）, ankle ROM and complications were also recorded at the final follow-ups. Results The 14 patients obtained an average follow-up of 28.6 months （from 14 to 35 months）. Bony union was achieved after an average of 3.7 months （from 3 to 6 months）. At the final follow-ups, on average, VAS score （2.2 ±0. 8）, AOFAS ankle and hindfoot score （81.1±6. 8）, SF-36 score （82. 5 ±5.2）, dorsal extension （27.5°± 2.5°）, and plantar flexion （24.2°±6.3°） were significantly improved compared with the preoperative values （6. 3±1.8, 43.1±12.0, 37.6±9.9, 14.1°±3.8°and 14.4°±3.9°, respectively） （P 〈0.05）. No implant failure, soft tissue complications or post-traumatic arthritis occurred during the follow-up. Conclusion Since our self-designed 3D printing relay templates for osteotomy can accurately position the fracture lines of the distal tibia via limited incision and invasion, they help a lot in precise osteotomy and anatomical reduction of malunited intra-articular ankle fracture, preventing incidence of traumatic arthritis.
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2017年第6期511-517,共7页
Chinese Journal of Orthopaedic Trauma
基金
江西省科技支撑计划资助项目（20151BBG70119）
关键词
踝关节
骨折
外科手术
计算机辅助
3D打印
Ankle joint
Fractures, bone
Surgery, computer-assisted
3D printing
