Nie Wei, Gu Fei, Wang Zhaojun, Wu Rui, Yue Yang, Shao Anze
Department of Orthopaedic Surgery, Lianyungang Second People's Hospital, China.
Department of Orthopaedic Surgery, Lianyungang Second People's Hospital, China.
Injury. 2019 Feb;50(2):476-483. doi: 10.1016/j.injury.2018.12.019. Epub 2018 Dec 17.
Surgical management of bicondylar tibial plateau fractures, which is frequently associate with high wound complication rates and functional impairment, remains a challenge for orthopedic surgeons. Recently, the emergence of three-dimension(3D) printing provided orthopedic surgeons with a new technology which has revolutionary impacts on surgical planning, operative guidance and custom-made implants manufacture. The aim of this study is to explore the clinical feasibility and application value of 3D printing in the surgical management of bicondylar tibial plateau fractures.
Data of this retrospective study was collected from 11 patients suffering bicondylar tibial plateau fracture from October 2015 to August 2016. All of them underwent surgical treatment with the assistance of 3D printing technology. Real-size solid models and screw guide templates were printed for preoperative planning, surgical simulation and intraoperative guidance. Patients' Demographics, surgery duration, intraoperative blood loss, the accuracy of preoperative planning were recorded and evaluated.
The 3D printed models successfully provided the omni-directional exhibition of the fracture morphology. Model-based surgical simulation procedures and pre-selection of implants were generally consistent with the results of actual surgeries. There were no significant differences between the length of the osteosynthesis screws and that of actual surgeries (59.43 ± 11.13 mm vs 60.14 ± 12.05 mm). Beyond that, other parameters, such as surgical duration, intraoperative blood loss and HSS scores was satisfactory according to the surgical records and follow-up.
According to our experience, the assistance of 3D printing technology in the surgical management of bicondylar tibial plateau fractures provides a comprehensive understanding of fracture features, an accurate patient-specific preoperative planning and an intraoperative guidance for real surgeries, thus leading to the optimization of clinical outcomes.
双髁胫骨平台骨折的手术治疗常伴有较高的伤口并发症发生率和功能障碍，这对骨科医生来说仍然是一个挑战。近年来，三维（3D）打印技术的出现为骨科医生提供了一项新技术，该技术在手术规划、手术导航和定制植入物制造方面具有革命性的影响。本研究的目的是探讨3D打印技术在双髁胫骨平台骨折手术治疗中的临床可行性和应用价值。
本回顾性研究收集了2015年10月至2016年8月期间11例双髁胫骨平台骨折患者的数据。所有患者均在3D打印技术的辅助下接受了手术治疗。打印了实物大小的实体模型和螺钉导向模板，用于术前规划、手术模拟和术中导航。记录并评估患者的人口统计学资料、手术时间、术中出血量、术前规划的准确性。
3D打印模型成功地提供了骨折形态的全方位展示。基于模型的手术模拟程序和植入物的预选与实际手术结果基本一致。接骨螺钉的长度与实际手术的长度之间无显著差异（59.43±11.13mm对60.14±12.05mm）。除此之外，根据手术记录和随访情况，其他参数，如手术时间、术中出血量和HSS评分均令人满意。
根据我们的经验，3D打印技术辅助双髁胫骨平台骨折的手术治疗，能够全面了解骨折特征，提供准确的个性化术前规划和实际手术的术中导航，从而优化临床治疗效果。
