【摘要】 目的 探讨3D打印个性化体内导板辅助髋臼下螺钉置钉治疗髋臼骨折的有效性和安全性。方法 回顾性分析2020年1月至2022年12月期间新疆医科大学附属中医医院骨科采用髋臼下螺钉治疗的髋臼骨折患者资料。根据是否使用3D打印个性化髋臼下螺钉导板分为两组：徒手置钉组18例，其中男性16人，女性2人，平均年龄46.61±13.82岁。前柱骨折2例，前柱伴后半横行骨折5例，T型骨折2例，双柱骨折9例。导板组20人，其中男性17人，女性3人，平均年龄41.80±16.75岁。前柱骨折2例，前柱伴后半横行骨折6例，T型骨折2例，双柱骨折10例。记录并比较两组患者的手术时间、出血量、术中累计透视次数、骨折复位质量、功能评定结果及并发症发生情况等。结果 38例患者术后随访时间11—27个月，平均18.1个月。徒手置钉组手术时间192.00±40.44min、术中出血量818.33±191.38ml、透视次数11.33±1.68次显著多于导板组165.00±29.48min、667.50±201.88ml、8.70±2.03次，差异具有统计学意义（P<0.05）。两组患者术后Matta评分、术后三月Matta评分及末次随访Merled’Aubigne-Postel评分差异无统计学意义（P>0.05）。徒手置钉组术后出现2例股外侧皮神经损伤，1例切口感染，1例创伤性关节炎。导板组出现1例股外侧皮神经损伤，1例切口感染。两组患者并发症发生率对比无统计学差异（P>0.05）。结论3D打印个性化髋臼下螺钉导板辅助置钉能减少术中透视次数、缩短手术时间、减少术中出血量，临床疗效满意。更多还原

【Abstract】 Objective To investigate the efficacy and safety of 3D printed personalized in vivo guide assisted infra-acetabular screws placement in the treatment of acetabular fracture.MethodsThe clinical data of patients with acetabular fracture treated with infra-acetabular screws in the Department of Orthopaedics, Affiliated Hospital of Traditional Chinese Medicine, Xinjiang Medical University from January 2020 to December 2022 were analyzed retrospectively.They were divided into two groups according to whether 3D printed personalized infra-acetabular screws guides were used or not: 18 patients in the free-hand screw placement group, including16 males and 2 females, with an average age of 46.61 ± 13.82 years.There were 2 anterior column fractures, 5 anterior column with posterior hemitransverse fractures, 2 T-type fractures, and 9 bicolumnar fractures.There were 20 patients in the guide group, including 17males and 3 females, with a mean age of 41.80 ± 16.75 years.There were 2 anterior column fractures, 6 anterior column with posterior hemitransverse fractures, 2 T-type fractures, and 10 bicolumnar fractures.The operation time, blood loss, cumulative fluoroscopy times,fracture reduction quality, functional evaluation results and complications were recorded and compared between the two groups.Results38 patients were followed up for 11-27 months, with an average of 18.1 months.The operation time of 192.00 ± 40.44 min, intraoperative blood loss of 818.33 ± 191.38ml and fluoroscopy times of 11.33 ± 1.68 times in free-hand screw placement group were significantly more than 165.00 ± 29.48 min, 667.50 ± 201.88ml and 8.70 ± 2.03 times in guide plate group, and the differences had statistical significance(P < 0.05).There was no significant difference in postoperative Matta score, postoperative Matta score at 3 months and Merled ’Aubigne-Postel score at the last follow-up between the two groups(P > 0.05).In the free-hand screw placement group, there were 2 cases of lateral femoral cutaneous nerve injury, 1 case of incision infection and 1 case of traumatic arthritis after operation.In the guide plate group, there was 1 case of lateral femoral cutaneous nerve injury and 1 case of incision infection.The difference in the incidence rate of complications between the two groups had no statistical significance(P > 0.05).Conclusion3D printing personalized infra-acetabular screws guide assisted screw placement can reduce the number of intraoperative fluoroscopy, shorten the operation time,reduce intraoperative blood loss, and the clinical efficacy is satisfactory.更多还原