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桡骨远端骨折约占四肢骨折病人的15%,发病率高且易累及关节面[1]。此类骨折常具有以下特点:桡骨长度短缩、累及关节面、粉碎性骨折及骨折断端明显的成角畸形。对桡骨远端不稳定性骨折进行保守治疗,容易发生骨折复位后位置丢失,且很难实现关节面的解剖复位,造成骨折畸形愈合、腕关节创伤性关节炎,导致顽固性腕关节疼痛及功能受限。因此,对桡骨远端不稳定性骨折进行手术干预是目前多数临床医生的选择。切开复位锁定钛板内固定具有直接复位骨折,稳定性良好,功能恢复快的优点[2-4],但亦可引起腱鞘炎、肌腱断裂,且需要再次手术取出内固定[5-7]。我院采用3D打印辅助下闭合或有限切开复位外固定支架外固定方法治疗桡骨远端不稳定性骨折,临床疗效满意。现作报道。
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2组病人均顺利完成手术。MIS组病人手术时间明显短于ORIF组(P<0.01),手术切口长度亦明显短于ORIF组(P<0.01)(见表 1)。本组25例术后均获得随访。MIS组骨折复位良好,关节面平整,桡骨长度、掌倾角、尺偏角均恢复,克氏针按术前设计位置固定良好(见图 4~5)。ORIF组病人骨折复位良好,关节面平整,桡骨长度、掌倾角、尺偏角均恢复,接骨板及螺钉位置良好(见图 6~7)。
分组 n 手术时间/min 切口长度/cm MIS组 12 49.02±7.29 2.92±1.88 ORIF组 13 75.79±3.98 6.61±1.12 t — 11.52* 5.44 P — <0.01 <0.01 *示t′值 表 1 2组病人手术时间和手术切口长度比较(x±s)
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2组病人术后腕关节掌屈、背伸、尺偏、桡偏、旋前、旋后六个方向的活动度差异均无统计学意义(P>0.05)(见表 2)。MIS组病人根据腕关节功能评分,优、良、可病人例数分别为9、2、1例,ORIF组病人优、良、可例数分别为8、4、1例,2组均无评分差的病人。MIS组病人评分优良率为91.67%(11/12),与ORIF组的92.31%(12/13)差异无统计学意义(Fisher′s确切概率法,P>0.05)。
分组 n 掌屈 背伸 旋前 旋后 桡偏 尺偏 MIS组 12 50.63±1.67 50.40±1.92 80.93±2.11 79.55±1.47 24.47±1.96 30.39±1.31 ORIF组 13 52.26±2.20 51.08±2.02 80.68±2.08 80.45±2.66 25.44±2.05 30.11±3.03 t — 0.47 0.86 0.30 1.04 1.21 0.30 P — >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 表 2 2组病人腕关节活动度的比较(x±s;°)
3D打印技术在桡骨远端不稳定性骨折微创治疗中的应用
Clinical application value of 3D printing technology in the mini-invasive treatment of unstable distal radius fractures
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摘要:
目的探讨3D打印技术辅助下微创手术在桡骨远端不稳定性骨折治疗中的临床应用。 方法选取桡骨远端不稳定性骨折病人25例,分为3D打印技术辅助下微创(闭合或有限切开)复位克氏针内固定外固定支架外固定组(MIS组)12例和切开复位锁定板内固定组(ORIF组)13例。比较2组病人手术时间和切口长度,术后随访病人腕关节掌屈、背伸、尺偏、桡偏、旋前、旋后六个方向的活动度,复查腕关节正侧位片,观察对掌倾角、尺偏角、桡骨长度及关节面恢复情况,应用Gartland-Werley腕关节功能评分表对2组病人腕关节功能进行评分并比较。 结果2组病人均顺利完成手术,MIS组手术时间明显短于ORIF组(P < 0.01),手术切口长度明显小于ORIF组(P < 0.01)。2组病人术后腕关节均复位良好,腕关节活动度和功能评分优良率差异均无统计学意义(P>0.05)。 结论应用3D打印技术辅助下微创(闭合或有限切开)复位克氏针内固定外固定支架外固定治疗桡骨远端不稳定性骨折,切口小,手术时间短,腕关节功能恢复良好,且可避免二次手术。 Abstract:ObjectiveTo investigate the clinical application value of 3D printing technology in the mini-invasive treatment of unstable distal radius fractures. MethodsTwenty-five patients with unstable distal radius fracture were divided into the MIS group(12 cases) and ORIF group(13 cases).The MIS group and ORIF group were treated with mini-invasive surgery reduction(close reduction or limited incision reduction) combined with external fixation assisted by 3D printing technology, and open reduction combined with internal fixation, respectively.The operation time, incision size and postoperative following-up of the activity of wrist motion(palmarflexion, dorsiflexion, ulnardeviation, radialdeviation, pronation, supinaion) were compared between two groups.The recovery of palmar inclination, ulnar deviation, radial length and joint surface in two groups were observed using the positive and lateral wrist radiographs.According to Gartland-Werley scoring criteria, the wrist joint function between two groups was evaluated and compared. ResultsThe operation in two groups was successfully completed, and the average operation time and incision length in MIS group were less than those in ORIF group(P < 0.01).The recovery of wrist joint function in two groups was good, and the differences of the excellent and good rate of the activity of the wrist motion, and score of wrist joint function between two groups were not statistically significant(P>0.05). ConclusionsThe mini-invasive surgery reduction(close reduction or limited incision reduction) combined and external fixation assisted by 3D printing technology combined with open reduction and internal fixation in the treatment of the unstable distal radius fractures has little incision, short operation time and good recovery of wrist joint function, which can avoid secondary surgery. -
Key words:
- radius fracture /
- 3D printing /
- minimal invasion /
- external fixation /
- internal fixation
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表 1 2组病人手术时间和手术切口长度比较(x±s)
分组 n 手术时间/min 切口长度/cm MIS组 12 49.02±7.29 2.92±1.88 ORIF组 13 75.79±3.98 6.61±1.12 t — 11.52* 5.44 P — <0.01 <0.01 *示t′值 表 2 2组病人腕关节活动度的比较(x±s;°)
分组 n 掌屈 背伸 旋前 旋后 桡偏 尺偏 MIS组 12 50.63±1.67 50.40±1.92 80.93±2.11 79.55±1.47 24.47±1.96 30.39±1.31 ORIF组 13 52.26±2.20 51.08±2.02 80.68±2.08 80.45±2.66 25.44±2.05 30.11±3.03 t — 0.47 0.86 0.30 1.04 1.21 0.30 P — >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 -
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