摘要
目的比较3D打印导板辅助与徒手置入空心螺钉治疗SandersⅡ、Ⅲ型跟骨骨折的临床疗效。方法采用回顾性队列研究分析2020年6月至2022年10月重钢总医院收治的29例SandersⅡ、Ⅲ型跟骨骨折患者的临床资料,其中男18例,女11例;年龄22~69岁[(40.1±11.5)岁]。19例采用个体化3D打印导板辅助经皮置入空心螺钉内固定治疗(3D打印组),10例采用徒手置入空心螺钉内固定治疗(徒手组)。比较两组手术时间、透视次数、术后6个月的跟骨形态(长度、宽度、高度、Böhler角、Gissane角),以及术后3,6个月及末次随访时美国足踝外科学会(AOFAS)踝⁃后足评分和Maryland功能评分。观察切口愈合及并发症情况。结果患者均获随访6~24个月[(11.3±2.5)个月]。3D打印组手术时间和透视次数分别为(53.4±9.1)min、(7.3±1.1)次,少于徒手组的(90.2±16.0)min、(16.0±3.2)次(P均<0.01)。术后6个月,两组跟骨长度差异无统计学意义(P>0.05);3D打印组跟骨宽度为(34.0±1.8)mm,高度为(47.2±1.6)mm,Böhler角为(27.8±1.0)°,Gissane角为(129.2±2.8)°,优于徒手组的(37.5±2.0)mm、(43.0±2.7)mm、(25.8±1.5)°、(125.9±2.5)°(P均<0.01)。术后3,6个月及末次随访时,3D打印组AOFAS踝⁃后足评分分别为(72.2±2.3)分、(79.7±2.3)分、(86.5±4.4)分,高于徒手组的(64.2±6.9)分、(73.4±4.2)分、(81.8±3.1)分(P均<0.05);3D打印组Maryland评分分别为(71.4±7.7)分、(84.7±2.6)分、(91.5±2.5)分,高于徒手组的(65.2±5.6)分、(79.1±3.8)分、(87.1±2.9)分(P均<0.05)。术后切口均Ⅰ期愈合。3D打印组术后未出现感染、医源性血管神经损伤及内固定断裂等并发症;徒手组术后发生腓肠外侧皮神经症状1例,未行特殊治疗后自行恢复。结论与徒手置入空心螺钉内固定相比,3D打印导板辅助经皮置入空心螺钉治疗SandersⅡ、Ⅲ型跟骨骨折,具有手术时间短、透视次数少、复位丢失少、踝关节功能恢复好、并发症少等优势。
Objective To compare the efficacy of 3D⁃printed guide plate assisted versus freehand placement of cannulated screws for the treatment of Sanders type II and III calcaneal fractures.Methods A retrospective cohort study was conducted to analyze the clinical data of 29 patients with Sanders type II and III calcaneal fractures admitted to Chonggang General Hospital from June 2020 to October 2022.Among them,there were 18 males and 11 females,with an age range of 22⁃69 years[(40.1±11.5)years].Nineteen patients were treated with individualized 3D⁃printed guide plate assisted placement of cannulated screws(3D⁃printed group)and 10 were treated with freehand placement of cannulated screws(freehand group).The surgical time,fluoroscopy times,postoperative 6⁃month calcaneal morphology(length,width,height,Böhler angle and Gissane angle),and American Orthopedic Foot and Ankle Society(AOFAS)ankle⁃hindfoot score and Maryland functional score assessed at 3,6 months after operation and at the final follow⁃up were compared between the two groups.The incision healing and complications were observed.Results The patients were followed up for 6⁃24 months[(11.3±2.5)months].The surgical time and fluoroscopy times in the 3D⁃printed group were(53.4±9.1)minutes and(7.3±1.1)times,respectively,which were shorter than(90.2±16.0)minutes and(16.0±3.2)times in the freehand group(all P<0.01).At 6 months after operation,there was no significant difference in calcaneal length between the two groups(P>0.05);the calcaneal width,height,Böhler angle and Gissane angle in the 3D⁃printed group[(34.0±1.8)mm,(47.2±1.6)mm,(27.8±1.0)°,(129.2±2.8)°]were superior than those in the freehand group[(37.5±2.0)mm,(43.0±2.7)mm,(25.8±1.5)°,(125.9±2.5)°](all P<0.01).At 3,6 months after operation and at the final follow⁃up,the values of AOFAS ankle⁃hindfoot score in the 3D⁃printed group[(72.2±2.3)points,(79.7±2.3)points,(86.5±4.4)points]were higher than those in the freehand group[(64.2±6.9)points,(73.4±4.2)points,(81.8±3.1)points](all P<0.05);the values of Maryland score in the 3D⁃printed group[(71.4±7.7)points,(84.7±2.6)points,(91.5±2.5)points]were higher than those in the freehand group[(65.2±5.6)points,(79.1±3.8)points,(87.1±2.9)points](all P<0.05).All surgical incisions were healed in stage I.In the 3D⁃printed group,there were no complications regarding infection,iatrogenic vascular or nerve injury,or fixation failure after surgery.In the freehand group,one patient with lateral sural cutaneous nerve injury was resolved spontaneously without specific treatment.Conclusion Compared with freehand placement of cannulated screws,3D⁃printed guide plate assisted placement of percutaneous placement has the advantages of shorter surgical time,fewer fluoroscopy times,lower reduction loss,better ankle joint function recovery,and less complications in treating Sanders type II and III calcaneal fractures.
作者
宋奇志
李涛
奉成斌
林亚军
王华红
胡锦标
裴建祥
田中
宋伟
吴崇钦
Song Qizhi;Li Tao;Feng Chengbin;Lin Yajun;Wang Huahong;Hu Jinbiao;Pei Jianxiang;Tian Zhong;Song Wei;Wu Chongqin(Department of Orthopedic Surgery,Chonggang General Hospital,Chongqing 400080,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2023年第8期730-736,共7页
Chinese Journal of Trauma
基金
重庆市科卫联合医学科研项目(2020MSXM049)。
关键词
跟骨
骨折固定术
内
外科手术
打印
三维
Calcaneus
Fracture fixation,internal
Surgical procedures,operative
Printing,three⁃dimensional
