發(fā)布時間：2018-03-02 20:20

  本文選題：3D打印技術(shù)　切入點：髖臼　出處：《河南中醫(yī)藥大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的探究應(yīng)用3D打印技術(shù)輔助治療復(fù)雜型髖臼骨折的臨床療效。方法回顧性分析2013年10月至2015年10月期間收治、由同一醫(yī)師進行手術(shù)的的68例復(fù)雜髖臼骨折患者,其中男43例、女25例,年齡分布為24~56歲(平均36.4歲)。依Judet-Letournel分型為:雙柱骨折17例,后壁+后柱骨折22例,后壁+橫行骨折18例,T型骨折5例,前柱+前壁骨折6例。損傷因素:交通傷37例,墜落傷21例,建筑傷10例。合并傷:四肢骨折47例,骨盆骨折53例,顱腦損傷25例,休克18例,泌尿系損傷21例,臟器損傷11例,神經(jīng)損傷8例。受傷至手術(shù)時間為2~14d(平均6.8d)。其中28例患者經(jīng)螺旋CT掃描、三維快速成形術(shù)、計算機模擬及個體標(biāo)本模擬手術(shù),并根據(jù)術(shù)前計劃進行手術(shù)(3D組);40例患者采取常規(guī)術(shù)前檢查及手術(shù)(常規(guī)組)。運用統(tǒng)計學(xué)軟件分析比較兩組患者的切口長度、手術(shù)時間、出血量、骨折復(fù)位情況、手術(shù)并發(fā)癥、后期髖關(guān)節(jié)功能恢復(fù)情況。結(jié)果本課題所有數(shù)據(jù)經(jīng)嚴(yán)格要求搜集、審核與整理后顯示:術(shù)前兩組患者性別、年齡、受傷至手術(shù)時間、骨折分型、受傷原因及合并傷等一般資料無顯著差異(P0.05),具有可比性。3D組患者術(shù)中出血量、手術(shù)時間、切口長度均明顯低于常規(guī)組,差異具有統(tǒng)計學(xué)意義(P0.05)。術(shù)后一周骨折復(fù)位情況檢查顯示:常規(guī)組20例解剖復(fù)位、15例復(fù)位滿意、5例復(fù)位不滿意,滿意率為87.5%,3D組23例解剖復(fù)位、4例復(fù)位滿意、1例復(fù)位不滿意,滿意率96.4%,兩組患者復(fù)位情況差異具有統(tǒng)計學(xué)意義(P0.05),表明3D組術(shù)后骨折復(fù)位情況明顯優(yōu)于常規(guī)組。所有患者均采用門診隨訪、視頻隨訪、電話隨訪等方式復(fù)查髖關(guān)節(jié)功能恢復(fù)及并發(fā)癥情況,隨訪時間為6~18個月(平均12.6月),末次隨訪髖關(guān)節(jié)功能評分顯示:常規(guī)組17例優(yōu)、11例良、9例可、3例差,優(yōu)良率為70.0%,3D組23例優(yōu)、3例良、1例可、1例差,優(yōu)良率為92.9%,兩組復(fù)位情況差異具有統(tǒng)計學(xué)意義(P0.05),表明3D組術(shù)后髖關(guān)節(jié)功能評分明顯優(yōu)于常規(guī)組。并發(fā)癥情況:3D組、常規(guī)組分別出現(xiàn)股骨頭壞死0例、2例,二期均給予全髖置換術(shù)處理,創(chuàng)傷性關(guān)節(jié)炎2例、7例,異位骨化2例、6例,8例術(shù)前神經(jīng)損傷患者末次隨訪時均基本恢復(fù),兩組患者術(shù)后均未出現(xiàn)切口感染、靜脈血栓等其他并發(fā)癥,兩組并發(fā)癥差異比較具有統(tǒng)計學(xué)意義(P0.05),3D組并發(fā)癥發(fā)生率為14.3%,常規(guī)組并發(fā)癥發(fā)生率為37.5%,與常規(guī)組相比,3D組并發(fā)癥發(fā)生率明顯較低。結(jié)論1.在復(fù)雜髖臼骨折治療中應(yīng)用3D打印技術(shù),能簡化手術(shù)操作步驟、縮短手術(shù)時間,減少術(shù)中創(chuàng)傷及失血量、提高解剖復(fù)位率、降低術(shù)后并發(fā)癥發(fā)生率、改善后期關(guān)節(jié)功能,相對于傳統(tǒng)常規(guī)手術(shù)方式具有較大優(yōu)勢。2.應(yīng)用3D打印技術(shù)能提高復(fù)雜髖臼骨折手術(shù)治療質(zhì)量,優(yōu)化復(fù)雜髖臼骨折手術(shù)治療方案,使髖臼骨折患者在受到“一次打擊”后的“二次打擊”最小化,對骨科醫(yī)師臨床治療具有較好的指導(dǎo)意義。
[Abstract]:Objective to explore the clinical efficacy of 3D printing technique in the treatment of complex acetabular fractures. Methods 68 patients with complex acetabular fractures treated by the same physician from October 2013 to October 2015 were retrospectively analyzed, including 43 males. According to Judet-Letournel classification, there were 17 cases of double column fracture, 22 cases of posterior column fracture, 18 cases of posterior wall transverse fracture, 6 cases of anterior column fracture and 6 cases of anterior column fracture. There were 21 cases of falling injury, 10 cases of building injury, 47 cases of limb fracture, 53 cases of pelvic fracture, 25 cases of craniocerebral injury, 18 cases of shock, 21 cases of urinary system injury and 11 cases of visceral injury. There were 8 cases of nerve injury. The time from injury to operation was 214d (mean 6.8 days). Among them, 28 patients underwent spiral CT scan, three-dimensional rapid angioplasty, computer simulation and individual specimen simulation surgery. According to the preoperative plan, 40 patients in the 3D group underwent routine preoperative examination and operation (routine group). The incision length, operative time, bleeding volume, fracture reduction, and surgical complications were analyzed and compared by statistical software between the two groups. Results all the data were collected, examined and sorted out: sex, age, time from injury to operation, fracture classification, and so on. There was no significant difference in general data of injury cause and complicated injury (P 0.05). The amount of intraoperative bleeding, operation time and incision length in the comparable. 3D group were significantly lower than those in the routine group. The difference was statistically significant (P 0.05). The results of reduction examination at one week after operation showed that 20 cases of anatomical reduction in routine group were satisfactory in 15 cases and satisfactory in 5 cases, and the satisfaction rate was 87.5% in 23 cases of anatomic reduction and 4 cases of satisfactory reduction in 1 case. The satisfaction rate was 96.4. The difference between the two groups was statistically significant (P 0.05), which indicated that the reduction of fracture in the 3D group was better than that in the routine group. All the patients were followed up by outpatient and video. The functional recovery and complications of hip joint were reexamined by telephone follow-up. The follow-up time was 6 ~ 18 months (mean 12.6 months). The score of hip joint function in the last follow-up group showed that 17 cases were excellent and 11 cases were good and 9 cases were good and 3 cases were poor. The excellent and good rate was 70.0%. In the 3D group, 23 cases were excellent, 3 cases were good and 1 case was good, and the excellent and good rate was 92.9%. The difference between the two groups was statistically significant (P 0.05), which indicated that the score of hip joint function in the 3D group was obviously better than that in the routine group. In the routine group, there were 0 cases of osteonecrosis of femoral head, 2 cases were treated with total hip replacement, 2 cases were traumatic arthritis, 6 cases were ectopic ossification, and 8 cases had nerve injury before operation. No incision infection, venous thrombosis and other complications were found in both groups. The difference of complications between the two groups was statistically significant. The incidence of complications in the 3D group was 14.33.The complication rate in the routine group was 37.5. Compared with the conventional group, the incidence of complications in the 3D group was significantly lower than that in the conventional group. Conclusion 1.The technique of 3D printing was used in the treatment of complex acetabular fractures. It can simplify the operation procedure, shorten the operation time, reduce the trauma and blood loss during operation, increase the rate of anatomical reduction, reduce the incidence of postoperative complications, and improve the function of joint in the later stage. Compared with the conventional operation, 3D printing technique can improve the quality of surgical treatment of complex acetabular fractures and optimize the surgical treatment of complex acetabular fractures. So that the patients with acetabular fracture can be minimized after "one strike", which has a good guiding significance for orthopedic physicians in clinical treatment.
【學(xué)位授予單位】：河南中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R687.3;TP391.73

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