【摘要】：目的探討應(yīng)用筏釘技術(shù)結(jié)合3D打印治療伴有關(guān)節(jié)面塌陷脛骨平臺骨折的臨床療效。方法回顧分析2013年9月至2015年9月,銅陵市立醫(yī)院骨科收治的41例伴關(guān)節(jié)面塌陷的脛骨平臺骨折患者臨床資料。41例患者均采用切開復(fù)位和筏釘技術(shù)支撐塌陷關(guān)節(jié)面,并按不同的術(shù)前準(zhǔn)備方式分為3D組(16例)和普通組(25例)。3D組患者采用3D打印技術(shù)作為術(shù)前準(zhǔn)備,于3D模型上行術(shù)前規(guī)劃及手術(shù)演練;普通組患者行常規(guī)術(shù)前準(zhǔn)備。分別比較兩組患者在手術(shù)時(shí)間、術(shù)中出血量、圍手術(shù)期并發(fā)癥發(fā)生率、術(shù)中骨折一次性復(fù)位成功率、術(shù)后膝關(guān)節(jié)功能評分和關(guān)節(jié)面二次塌陷率的差異。結(jié)果所有患者均獲隨訪,隨訪時(shí)間9~18個(gè)月,平均11.71個(gè)月,3D組患者與普通組患者,在手術(shù)時(shí)間(80.94±18.09min和101.40±18.34min),術(shù)中出血量(77.19±24.36ml和111.60±38.64ml)、術(shù)中骨折一次性復(fù)位成功率(100%和72%)以及膝關(guān)節(jié)Rasmussen功能評分(24.88±5.32分和20.36±7.44分)的比較中,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。3D組患者在圍手術(shù)期無并發(fā)癥發(fā)生,而普通組患者中有1例術(shù)中出現(xiàn)脛前動脈損傷,術(shù)后有1例出切口感染,并予持續(xù)換藥至切口愈合;術(shù)后9個(gè)月,3D組患者和普通組患者分別有1例和4例發(fā)生關(guān)節(jié)面的二次塌陷,塌陷率分別為6.25%和16%。兩組患者在圍手術(shù)期并發(fā)癥發(fā)生率及關(guān)節(jié)面的二次塌陷率的比較中,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論筏釘技術(shù)結(jié)合3D打印治療伴有關(guān)節(jié)面塌陷的脛骨平臺骨折,可減少手術(shù)時(shí)間和術(shù)中出血量,提高術(shù)中骨折復(fù)位效率,改善術(shù)后膝關(guān)節(jié)功能。
[Abstract]:Objective to evaluate the clinical effect of rafting technique combined with 3D printing in the treatment of tibial plateau fracture with articular surface collapse. Methods from September 2013 to September 2015, 41 cases of tibial plateau fracture with articular surface collapse were retrospectively analyzed in the orthopaedic department of Tongling City Hospital. 41 patients were treated with open reduction and raft nail technique to support the collapse of the articular surface. The patients in 3D group were divided into 3D group (n = 16) and normal group (n = 25) according to different preoperative preparation methods. Patients in the general group were given routine preoperative preparation. The time of operation, the amount of intraoperative bleeding, the incidence of perioperative complications, the success rate of one-off reduction of intraoperative fracture, the score of knee joint function and the rate of secondary collapse of articular surface were compared between the two groups. Results all the patients were followed up for 9 ~ 18 months (mean 11.71 months). The operative time (80.94 鹵18.09min and 101.40 鹵18.34min), intraoperative bleeding volume (77.19 鹵24.36ml) and intraoperative bleeding volume (111.60 鹵38.64ml) in 3D group and normal group were 80.94 鹵18.09min and 101.40 鹵18.34min, respectively. The success rate of one-off reduction (100% vs 72%) and the Rasmussen score of knee joint (24.88 鹵5.32 and 20.36 鹵7.44) were compared. The difference was statistically significant (P0.05). There were no complications in the perioperative period in the 3D group, while 1 case in the common group had anterior tibial artery injury during the operation, and 1 case had wound infection after operation, and continued to change the dressing until the incision healed. 9 months after operation, 1 case in 3D group and 4 cases in normal group had secondary collapse of articular surface, the collapse rates were 6.25% and 16%, respectively. There was no significant difference in the incidence of perioperative complications and the secondary collapse rate of articular surface between the two groups (P0.05). Conclusion the treatment of tibial plateau fractures with articular surface collapse by rafting technique combined with 3D printing can reduce the operative time and blood loss, improve the reduction efficiency and improve the function of knee joint after operation.
【學(xué)位授予單位】：安徽醫(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

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