【摘要】 [目的]探讨3D打印个性化模型辅助治疗踝关节骨折的疗效。[方法]回顾性分析2021年1月—2023年4月手术治疗67例踝关节骨折患者的临床资料。依据术前医患沟通结果，32例采用3D打印个性化模型辅助小切口开放复位内固定（3D组），另外35例采用常规小切口开放复位内固定术（常规组）。对比两组围手术期、随访及影像指标。[结果]67例患者均顺利完成手术，3D组手术时间[(100.6±12.4) min vs(124.5±14.8) min, P<0.001]、术中失血量[(89.4±10.2) mL vs(115.0±13.0) m L, P<0.001]、术中透视次数[(12.5±3.7)次vs(14.7±4.3)次, P=0.029]、住院时间[(14.7±2.8) d vs(15.4±2.6) d, P<0.001]及下地行走时间[(17.0±3.2) d vs(19.0±4.0) d, P<0.001]均显著优于常规组。此外，3D组完全负重活动时间[(115.3±20.4) d vs(129.8±21.7) d, P=0.007]显著早于常规组。随时间推移，两组术后VAS评分、AOFAS评分、背伸-跖屈及内-外翻ROM均显著改善（P<0.05），术后1个月及末次随访时，3D组VAS评分[(4.0±0.) vs(4.8±1.0), P<0.001;(0.9±0.3) vs(1.1±0.3), P=0.008]、AOFAS评分[(77.2±7.8) vs(73.4±6.7), P=0.036;(93.0±4.6) vs(90.6±5.0), P=0.046]、背伸-跖屈ROM及内-外翻ROM均显著优于常规组（P<0.05）。影像方面，两组骨折复位质量比较差异无统计学意义（P>0.05）；两组术后胫踝角（tibiocrural angle, TCA）、踝内侧间隙（medial clear space,MCS）、胫腓间隙（tibiofibular clear space, TFCS）均显著改善（P<0.05）,3D组术后即刻TCA、MCS、TFCS显著均优于常规组（P<0.05），两组末次随访TCA、MCS、TFCS对比差异均无统计学意义（P>0.05）。[结论] 3D打印个性化模型辅助开放复位内固定治疗踝关节骨折，提升手术效率，有利于踝关节功能恢复。更多还原

【Abstract】 [Objective] To explore the clinical efficacy of 3D printing assisted small-incision open reduction and internal fixation(ORIF) of ankle fractures. [Methods] A retrospective study was performed on 67 patients who had ankle fractures treated surgically from January2021 to April 2023. According to the preoperative doctor-patient communication, 32 patients received 3D printing assisted small-incision ORIF, while the other 35 patients underwent conventional small-incision ORIF. The perioperative period, follow-up and imaging data of the two groups were compared. [Results] All the 67 patients had ORIF performed successfully. The 3D group proved significantly superior to the conventional group in terms of operation time [(100.6±12.4) min vs(124.5±14.8) min, P<0.001], intraoperative blood loss [(89.4±10.2) m L vs(115.0±13.0) mL, P<0.001], intraoperative fluoroscopy times [(12.5±3.7) times vs(14.7±4.3) times, P=0.029], hospital stay [(14.7±2.8) days vs(15.4±2.6) days, P<0.001] and ambulation time [(17.0±3.2) days vs(19.0±4.0) days, P<0.001]. In addition, the former resumed full weight-bearing activity significantly earlier than the latter [(115.3±20.4) days vs(129.8±21.7) days, P=0.007]. As time went on, the VAS and AOFAS scores, as well as dorsal-plantar flexion ROM and inversion-eversion ROM in both groups were significantly improved(P<0.05). At 1 month after surgery and the last follow-up, the 3D group was significantly better than the conventional group in terms of VAS score [(4.0±0.) vs(4.8±1.0), P<0.001;(0.9±0.3) vs(1.1±0.3), P=0.008], AOFAS score [(77.2±7.8) vs(73.4±6.7), P=0.036;(93.0±4.6) vs(90.6±5.0), P=0.046], dorsal-plantar flexion ROM and inversion-eversion ROM(P<0.05). Regarding imaging, there was no significant difference in the quality of fracture reduction between the two groups(P>0.05). The tibiocrural angle(TCA), medial clear space(MCS) and tibiofibular clear space(TFCS) were significantly improved in both groups after surgery compared with those preoperatively(P<0.05). The 3D group got significantly better TCA, MCS and TFCS than the conventional group immediately postoperatively(P<0.05), whereas which became not statistically significant between the two groups at the last follow-up(P>0.05). [Conclusion] 3D printing assisted small-incision open reduction and internal fixation of ankle fracture does improve surgical efficiency and is conducive to ankle functional recovery.更多还原