本文選題：3D打印技術(shù) + 橋接組合式內(nèi)固定系統(tǒng)(OBS)��； 參考：《昆明醫(yī)科大學(xué)》2017年碩士論文

【摘要】：[目的]肱骨近端骨折(Proximal Humeral Fracture PHF)是臨床常見骨折類型,嚴(yán)重地影響現(xiàn)代人生活質(zhì)量。目前,隨著社會文明進(jìn)程加快及現(xiàn)代醫(yī)學(xué)的快速發(fā)展,PHF病人絕大多數(shù)都能夠得到較為有效的治療,肩關(guān)節(jié)的功能得到一定恢復(fù),但臨床治療效果并不十分讓人滿意。常常出現(xiàn)患肢疼痛或肩關(guān)節(jié)活動功能不同程度受限等。本文通過探討3D打印技術(shù)結(jié)合橋接組合式內(nèi)固定系統(tǒng)(Ortho-Bridge System OBS)在治療PHF的臨床療效,為臨床治療PHF提供一種新的思路和方法。[方法]收集昆明醫(yī)科大學(xué)附屬延安醫(yī)院骨創(chuàng)傷科2014年9月-2016年06月期間收治的47例PHF病例資料。選取肱骨近端骨折Neer分型中二、三、四部分骨折病人,根據(jù)收治病人日期奇偶將病人隨機(jī)分為橋接組和鋼板組。橋接組總共24例,鋼板組23例。術(shù)前均行CT檢查及三維重建。橋接組應(yīng)用3D打印技術(shù)建模,按1:1比例打印骨折及復(fù)位模型,術(shù)前在模型上應(yīng)用OBS模擬手術(shù)復(fù)位及固定。手術(shù)主要采用三角肌胸大肌入路,術(shù)中復(fù)位后采用OBS植入固定骨折。鋼板組使用肱骨近端鎖定鋼板(Looking Proximal Humerus Plate)進(jìn)行固定治療。定期復(fù)查X片及觀察肩關(guān)節(jié)功能恢復(fù)情況,并應(yīng)用Constant-Murley系統(tǒng)進(jìn)行患肢功能評分。通過統(tǒng)計分析兩組患者手術(shù)時間、出血量、骨折愈合時間、并發(fā)癥發(fā)生情況、功能恢復(fù)優(yōu)良率等指標(biāo)分析3D打印技術(shù)結(jié)合OBS在治療PHF臨床療效。[結(jié)果]橋接組患者骨折全部愈合,鋼板組出現(xiàn)一例骨折延遲愈合。橋接組肩關(guān)節(jié)Constant-Murley系統(tǒng)評分優(yōu)良率為92%,鋼板組為86%。統(tǒng)計數(shù)據(jù)分析得出:兩組平均手術(shù)切口長度、平均術(shù)中出血量(Mean bleeding volum MBV)及肩關(guān)節(jié)功能優(yōu)良率方面無統(tǒng)計學(xué)意義。3D打印技術(shù)結(jié)合OBS治療PHF在術(shù)后并發(fā)癥、骨折愈合時間、射線暴露次數(shù)及平均手術(shù)時間(Mean operating time MOT)方面較肱骨近端鎖定鋼板更有優(yōu)勢。兩組患者對肩關(guān)節(jié)功能恢復(fù)基本滿意。[結(jié)論]1、固定強(qiáng)度:OBS在治療PHF時,多平面的內(nèi)固定方式堅強(qiáng)可靠,充分滿足患肢早期功能鍛煉要求。2、操作性:OBS結(jié)合3D打印模型,能術(shù)前完成內(nèi)固定物組合配置、及塑形,操作簡便。3、臨床效果:OBS結(jié)合3D打印模型治療肱骨近端骨折,療效確切,是肱骨近端骨折手術(shù)治療的不錯選擇。4、個性化及精準(zhǔn)化:術(shù)前可根據(jù)3D骨折復(fù)位模型,利用OBS棒塊組合靈活性,可為患者制定完善的手術(shù)規(guī)劃、最優(yōu)化及個性化精準(zhǔn)的OBS內(nèi)固定物。同時也促了進(jìn)骨科臨床工作向精準(zhǔn)化、個體化方向發(fā)展。
[Abstract]:[objective] Proximal Humeral Fracture PHF) is a common fracture type of proximal humerus fracture, which seriously affects the quality of life of modern people. At present, with the acceleration of social civilization and the rapid development of modern medicine, most patients with PHF can get more effective treatment, and the function of shoulder joint can be recovered to some extent, but the effect of clinical treatment is not very satisfactory. There is often pain in the affected limbs or limited function of the shoulder joint to varying degrees. In this paper, we discuss the clinical effect of ortho-Bridge System OBSs in the treatment of PHF by using 3D printing technology combined with bridged composite internal fixation system, and provide a new way of thinking and method for clinical treatment of PHF. [methods] 47 cases of PHF were collected from the Department of Bone Trauma of Yan'an Hospital affiliated to Kunming Medical University from September 2014 to June 2016. Patients with fracture of proximal humerus were randomly divided into bridging group and plate group according to the date of treatment. There were 24 cases in bridge group and 23 cases in plate group. Ct and three-dimensional reconstruction were performed before operation. The bridge group was modeled by 3D printing technique. The fracture and reduction model was printed according to 1:1 scale. OBS was used to simulate the surgical reduction and fixation before operation. The main operation was the deltoid muscle pectoralis major approach. The fracture was fixed by OBS implantation after reduction. The proximal humerus locking Proximal Humerus Plate) was used for fixation in the plate group. X-ray examination and functional recovery of shoulder joint were observed, and Constant-Murley system was used to evaluate the function of affected limbs. The clinical efficacy of 3D printing combined with OBS in the treatment of PHF was analyzed by statistical analysis of the operation time, bleeding volume, fracture healing time, complications and the excellent and good rate of functional recovery in the two groups. [results] the fracture healed in bridge group and delayed union in plate group. The excellent and good rate of shoulder joint Constant-Murley system score in bridge group was 92 and that in steel plate group was 86. Statistical data analysis showed that there was no significant difference between the two groups in terms of average operative incision length, mean blood loss during operation and the excellent and good rate of shoulder joint function. There was no significant difference between the two groups in the treatment of postoperative complications and fracture healing time with OBS combined with 3D printing. X-ray exposure and mean operative time were superior to proximal humerus locking plate in mean operating time MOT). The patients in both groups were satisfied with the recovery of shoulder joint function. [conclusion] 1. In the treatment of PHF, the multi-plane internal fixation method is strong and reliable, which fully meets the requirement of early functional exercise of affected limb .2.The operational ratio of OBS combined with 3D printing model can complete the internal fixation combination configuration and shape before operation. The clinical effect is: OBS combined with 3D print model to treat proximal humerus fracture. It is a good choice for surgical treatment of proximal humerus fracture. The flexible combination of OBS bar and block can make perfect operation planning, optimize and personalize accurate OBS internal fixation. At the same time, it also promotes the development of orthopedic clinical work in the direction of precision and individualization.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 葉軍;白龍;于志勇;;橋接組合式內(nèi)固定系統(tǒng)微創(chuàng)治療肱骨干粉碎性骨折[J];實用骨科雜志;2016年10期

2 王鋒;汪國棟;ChaoXie;劉曦明;Edward M.Schwarz;蔡賢華;齊鳳宇;鐘炎軍;;3D打印技術(shù)在髖臼后壁骨折手術(shù)治療中的應(yīng)用[J];中華創(chuàng)傷骨科雜志;2016年02期

3 邢金明;;切開復(fù)位鎖定鋼板內(nèi)固定術(shù)和人工半肩關(guān)節(jié)置換術(shù)治療老年肱骨近端復(fù)雜骨折的對比研究[J];中醫(yī)正骨;2015年08期

4 陳亮清;白龍;于志勇;葉軍;;交鎖髓內(nèi)釘治療肱骨近端骨折[J];臨床骨科雜志;2014年06期

5 張仲子;熊鷹;趙烽;張武;任云峰;;橋接組合式內(nèi)固定系統(tǒng)治療不穩(wěn)定型骨盆骨折[J];中外醫(yī)學(xué)研究;2014年27期

6 胡懷建;劉利民;沈惠良;;鎖定鈦板和近端髓內(nèi)釘治療肱骨近端骨折的療效分析[J];北京醫(yī)學(xué);2011年11期

7 戴斌;許建安;呂錦瑜;李志偉;李開華;陳剛;王培民;;人工肱骨頭置換治療老年肱骨近端粉碎性骨折[J];中國骨與關(guān)節(jié)損傷雜志;2009年05期

8 趙春明;范衛(wèi)民;王青;王道新;;肱骨近端解剖測量在人工肩關(guān)節(jié)置換中的意義[J];中國臨床解剖學(xué)雜志;2008年05期

9 王小建;孫玉明;;肱骨外科頸骨折的手術(shù)治療[J];長春中醫(yī)藥大學(xué)學(xué)報;2008年02期

10 黃強(qiáng),姜春巖,王滿宜;閉合復(fù)位經(jīng)皮穿針治療移位的肱骨外科頸骨折[J];中華創(chuàng)傷骨科雜志;2005年01期

，

本文編號：1909142