【摘要】 目的探讨3D打印辅助Sanders CT分型个性化手术治疗跟骨关节内骨折的临床疗效。方法收集湛江中心人民医院和廉江市人民医院2014年1月至2016年1月收治的36例跟骨关节内骨折患者的临床资料,其中18例采用传统切开复位内固定手术(传统手术组),18例行3D打印辅助Sanders CT分型个性化手术(个性化手术组)。个性化手术组术前采用3D打印技术制成1∶1的骨折实物模型,标记骨折线,结合冠状位和轴位CT影像进行Sanders CT分型,确定需要恢复的跟骨长度、宽度、Bohler角和Gissane角,辨认关节面碎骨块移位情况,据此制定手术方案,行外侧或内外侧联合入路手术。分别记录两组手术时间、住院时间;术后1周拍摄跟骨侧位X线片,测量跟骨长度、宽度、Bohler角及Gissane角;按踝关节Kofoed评分标准评估术后6个月踝关节功能。结果 36例患者获随访10~12个月(平均10.5个月)。传统手术组、个体化手术组手术时间和住院时间分别为(115±25)min和(14±4)d、(58±9)min和(14±3)d,后者手术时间更短(P<0.05),但两组住院时间比较,差异无统计学意义(P>0.05)。术后1周跟骨X线片各测量指标个性化手术组更佳(P<0.05)。传统手术组2例患者发生切口感染,经换药或负压封闭引流处理后痊愈。术后6个月所有患者骨折均愈合;传统手术组、个性化手术组Kofoed踝关节功能评分及优良率分别为(79±12)分和11/18、(93±14)分和17/18,个性化手术组明显优于传统手术组(P<0.05)。结论采用数字骨科技术重建跟骨骨折模型并打印1:1骨折实物模型,可在模型上标记骨折线、清晰辨认移位关节面骨折块并辅助进行Sanders CT分型,制订个性化手术方案;3D打印辅助Sanders CT分型个性化手术能够减少实际手术操作时间,获得对跟骨关节面的良好复位,提高手术的精确性和可靠性,术后功能恢复良好,是治疗跟骨关节内复杂骨折的较好选择。更多还原

【Abstract】 Objective To explore the clinical effects of individualized surgery for treatment of intra-articular calcaneal fractures according to 3D printing-assisted Sanders CT typing. Methods An retrospective study included 36 patients with intra-articular calcaneal fractures who were surgically treated in Zhanjiang Central People’s Hospital and Lianjiang People’s Hospital from January 2014 to January 2016. They were divided into two groups, conventional operation group(conventional open reduction and internal fixation, n = 18) and personalized operation group(operation according to 3D printing-assisted Sanders CT typing, n = 18). In personalized surgery group, 1∶1 fracture model was printed by 3D printing technique before the operation, the fracture line was marked, Sanders CT classification was then performed with the combination of coronal and axial CT images, to determine calcaneal length, width, Bohler and Gissane angles needed to restore, as well as identify the displaced bone fragments on the articular surface. As a result, operation plan was made, lateral approach or combined medial and lateral approach was performed. Operative time and hospital stay in two groups were recorded, calcaneal length, width, Bohler and Gissane angles 1 week after the surgery were observed by axial X-ray examination, functional evaluation at 6 months after the operation was accessed according to Kofoed score of ankle joint function. Results All patients were followed up from 10 to 12 months, with an average of 10.5 months. Operative time in personalized operation group was shorter than that in conventional operation group [(58 ± 9) vs(115 ± 25) min, P <0.05], while there was no statistical difference of hospital stay between two groups [(14 ± 3) vs(14 ± 4) d, P >0.05]. The radiological indexes 1 week postoperatively in personalized operation group were more superior than those in control group(P <0.05). Two cases of wound infection were found in conventional operation group, and cured after dressing change or vacuum sealing drainage therapy. At 6 months postoperatively, all patients achieved fracture healing; the score of Kofoed ankle function was 93 ± 14, the excellent and good rate was 17/18 in personalized operation group, all improved compared with those in control group(79 ± 12, 11/18), the differences between two groups had statistical significance(P <0.05). Conclusions Based on calcaneal fracture model reconstruction and physical model 3D printing by digital orthopedic technique, the fracture line could be marked in the model, the fracture fragments on the articular surface could be clearly identified, and the personalized surgical plan could be made according to the assistance of Sanders CT classfication. For intra-articular calcaneal fractures, individualized surgery according to 3D printing-assisted Sanders CT typing is a good choice because it could reduce the operative time, achieve good reduction for articular surface, enhance the accuracy and reliability of the surgery and obtain good functional rehabilitation.更多还原