摘要
目的探讨虚拟复位和3D打印导板设计在辅助髌骨粉碎性骨折复位与内固定手术中的作用。方法回顾性分析2016年3月至2019年4月江西省人民医院骨科收治的12例闭合性粉碎性髌骨骨折患者资料。男8例,女4例;平均年龄为35.4岁(22~51岁);根据AO/OTA分类,12例患者均为34-C3(3个以上碎片)型。将术前CT数据导入Mimics软件内打印出全髌骨和上、下部半髌骨及其复位导板,术中先分别在上、下部半髌骨复位导板的辅助下将碎骨块拼合,并以细克氏针临时固定;再在全髌骨复位导板的辅助下完成髌骨的精准复位与以髌骨环扎加张力带钢丝所作的终极固定。记录手术时间、术中透视次数、伤口愈合情况、骨折愈合时间,以及末次随访时疼痛的视觉模拟评分(VAS)、膝关节活动范围、膝关节功能Böstman评分。结果本组患者手术时间平均为90 min(75~120 min),术中透视次数平均为4.5次(3~8次)。所有患者术后获平均为19周(16~22周)的随访,骨折愈合时间平均为14周(11~17周);末次随访时X线片均示髌骨形态及内固定位置良好,VAS评分平均为0.3分(0~1分);膝关节均可充分伸直,膝关节活动范围平均为130°(100°~138°);膝关节Böstman评分平均为28.8分(21~30分),其中优9例,良3例。结论3D打印复位导板能够明显提升髌骨粉碎性骨折的手术复位效率与质量,提高固定强度,为膝关节早期、大幅度活动锻炼创造条件。
Objective To explore the role of virtual reduction and design of 3D printed guide template in assisting reduction and internal fixation of comminuted patellar fractures.Methods A retrospective study was conducted of 12 patients who had been treated for closed patellar fractures from March 2016 to April 2019 at Department of Orthopaedics,Jiangxi Provincial People's Hospital.They were 8 males and 4 females with an average age of 35.4 years(from 22 to 51).All their fractures were type 34-C3(more than 3 fragments)according to the AO/OTA classification.Their preoperative CT data were imported into software Mimics to print a full patella,upper and lower halves of the patella,and a guide template for reduction.During operation,bone fragments were first temporarily fixated with a fine Kirschner wire after combined together with the assistance of reduction templates for upper and lower hemi-patellas.Next,the whole patella was precisely reset and definitely fixated using patellar ring ligation and tension band wire with the assistance of the reduction guide template for full patellar.Recorded were operation time,fluoroscopic frequency,and visual analogue scale(VAS),knee range of motion(ROM)and knee function Böstman scores at the last follow-up.Results In this group of patients,operation time averaged 90 minutes(from 75 to 120 minutes),fluoroscopic frequency 4.5 times(from 3 to 8 times),follow-up duration 19 weeks(from 16 to 22 weeks),and fracture healing time 14 weeks(from 11 to 17 weeks).At their last follow-up,X-ray showed good patellar morphology,fine internal fixation positions and an average VAS pain scores of 0.3(from 0 to 1),their knee joints could be fully straightened,their knee ROM averaged 130°(from 100°to 138°),and their knee Böstman scores 28.8 points(from 21 to 30 points),giving 9 excellent and 3 good cases.Conclusion 3D printed reduction guide templates can significantly improve the efficiency and quality of surgical reduction in comminuted patella fractures,enhancing fixation strength and facilitating early and full range exercise of the knee joint to achieve excellent recovery.
作者
董谢平
龙智生
王哲
李经堂
熊龙
廖观祥
李晨
艾子政
李京娜
Dong Xieping;Long Zhisheng;Wang Zhe;Li Jingtang;Xiong Long;Liao Guanxiang;Li Chen;Ai Zizheng;Li Jingna(Department of Orthopaedics,Jiangxi Provincial People's Hospital Affiliated to Nanchang University,Nanchang 330006,China;Jiangxi Xiaoman Technology Co.Ltd,Nanchang 330006,China)
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2020年第10期876-880,共5页
Chinese Journal of Orthopaedic Trauma
关键词
髌骨
粉碎性骨折
复位术
3D打印
导板
Patella
Comminuted fracture
Reduction
3D printing
Guide template
