Wang Yu-Chen, Ma Yong, Yu Wei-Zhong, Li Yun-Feng, Liu Yan-Hui
The First Clinical Medical School of Nanjing University of Chinese Medicine, Nanjing 210046, Jiangsu, China;
Zhongguo Gu Shang. 2017 Jul 25;30(7):627-632. doi: 10.3969/j.issn.1003-0034.2017.07.009.
To investigate the computer-assisted virtual reduction combined with 3D printing technique as preoperative planning and assess their therapeutic effects.
Thirty-five cases of acetabular fracture treated by internal fixation from March 2011 and March 2014 were retrospectively analyzed. All patients underwent operations with internal fixations implanted. The patients were divided into 2 groups according whether they used the computer-assisted virtual reduction combined with 3D printing technology. Fifteen patients in the digital group included 9 males and 6 females with a mean age of (39.4±8.8) years old ranging from 22 to 58 years old;time from injury to the operation was (8.8±2.0) days;for Letournel-Judet classification, 4 cases were both column fracture, 5 cases were posterior wall fracture, 4 cases were T-fracture, 2 cases were posterior wall with transverse fracture. Twenty cases in the control group included 12 males and 8 females with a mean age of (38.7±13.1) years old ranging from 19 to 59 years old;time from injury to the operation was(8.2±2.3) days;for Letournel-Judet classification, 6 cases were both column fracture, 8 cases were posterior wall fracture, 3 cases were T-fracture, 3 cases were posterior wall with transverse fracture. The volume of intraoperative blood loss and blood transfusion, operative time, satisfaction rate of fracture reduction and excellent and good rate of d`Aubigne Postal function evaluation were compared between the two groups and statistical analysis was conducted.
All the incisions healed without infection occurred. All the fractures healed without breakage or loosening of plates and screws. There was 1 case of postoperative nerve stimulation symptoms in each group. One patient in the digital group was found necrosis of the femoral head at 6 months after operation. One patient in the control group was found heterotopic ossification at 8 months after operation. All patients were follow-up for 13 to 28 months with an average of 17.6 months. The volume of intraoperative blood loss and blood transfusion in the digital group were significantly less than those in the control group(<0.05). The operation time in the digital group was shorter than that in the control group(<0.05). The excellent and good rates of fracture reduction were 92.9%(14/15) and 85%(17/20) in the digital group and the control group respectively, and there was no statistical significance (>0.05). The excellent and good rates of Aubigne Postal function evaluation were 86.7%(13/15) and 80%(16/20) respectively, and there was no significant difference(>0.05).
The computer-assisted virtual reduction combined with 3D printing technique can reduce the operative time, volume of intraoperative blood loss and blood transfusion in acetabular surgeries for patients with acetabular fractures. The technique is an effective method for preoperative planning, which worth promoting.
探讨计算机辅助虚拟复位联合3D打印技术在髋臼骨折术前规划中的应用，并评估其治疗效果。
回顾性分析2011年3月至2014年3月采用内固定治疗的35例髋臼骨折患者。所有患者均接受内固定植入手术。根据是否使用计算机辅助虚拟复位联合3D打印技术将患者分为2组。数字组15例，男9例，女6例，平均年龄（39.4±8.8）岁，年龄范围22至58岁；受伤至手术时间为（8.8±2.0）天；按Letournel-Judet分型，双柱骨折4例，后壁骨折5例，T形骨折4例，后壁伴横形骨折2例。对照组20例，男12例，女8例，平均年龄（38.7±13.1）岁，年龄范围19至59岁；受伤至手术时间为（8.2±2.3）天；按Letournel-Judet分型，双柱骨折6例，后壁骨折8例，T形骨折3例，后壁伴横形骨折3例。比较两组患者术中失血量、输血量、手术时间、骨折复位满意率及d`Aubigne Postal功能评价优良率，并进行统计学分析。
所有切口均一期愈合，未发生感染。所有骨折均愈合，钢板及螺钉无断裂或松动。两组各有1例术后出现神经刺激症状。数字组1例患者术后6个月出现股骨头坏死。对照组1例患者术后8个月出现异位骨化。所有患者随访13至28个月，平均17.6个月。数字组术中失血量及输血量均显著少于对照组（<0.05）。数字组手术时间短于对照组（<0.05）。数字组与对照组骨折复位优良率分别为92.9%（14/15）和85%（17/20），差异无统计学意义（>0.05）。Aubigne Postal功能评价优良率分别为86.7%（13/15）和80%（16/20），差异无统计学意义（>0.05）。
计算机辅助虚拟复位联合3D打印技术可减少髋臼骨折患者髋臼手术的手术时间、术中失血量及输血量。该技术是一种有效的术前规划方法，值得推广。
