Department of Ortopaedic Surgery, Faculty of Medicine, Ege University, Izmir, TURKEY.
Department of Anatomy Digital Imaging and 3D Modelling Laboratory, Faculty of Medicine, Ege University, Izmir, TURKEY.
Injury. 2022 Oct;53 Suppl 2:S40-S51. doi: 10.1016/j.injury.2020.04.057. Epub 2020 May 13.
It was aimed to compare conventional surgery and three-dimensional (3D) model-assisted surgery used in the treatment of calcaneal fractures.
MATERIALS & METHODS: A total of 37 patients with unilateral calcaneal fractures were randomly divided into two groups as a conventional surgery group (n: 19) and a 3D model-assisted surgery group (n: 18). The preoperative, postoperative and last follow up angles of the Bohler and Gissane, calcaneal width and facet height were measured. The duration of the operation, blood loss volume, fluoroscopy usage, instrumentation time for both groups were recorded. Finally, the follow-up AOFAS scores were evaluated. A questionnaire was used to determine the perceptions of the resident doctors about the 3D model.
The duration of the operation, blood loss volume, fluoroscopy usage, instrumentation time for 3D model-assisted surgery group were 83.3 ± 4.6 minutes, 83.6 ± 4.6 ml, 6.8 ± 1.4 times and 13.0 ± 0.8 weeks, and as for conventional group they were 130.0 ± 5.8 minutes, 105.1 ± 5.6 minutes, 11.7 ± 1.5 ml, 22.2 ± 2.4 times and 13.3 ± 0.8 weeks, respectively (p < 0.0001). The both groups significantly restored Bohler angle, Gissane angle, calcaneal width and calcaneal facet height after operation (p < 0.0001). The 3D model-assisted group was significantly more succesful in restoration and protection of achieved correction of calcanel facet height (p < 0.0001). The difference was determined among the groups at the final follow-up examination with respect to the amount of change according the values achieved post-op. were significant in Bohler angle (p < 0.001), calcaneal facet height (p < 0.0001) and calcaneal widht (p = 0.017). There was no significant difference between AOFAS scores of the two groups at last follow-up. Resident doctors exhibited high scores of overall satisfaction with the use of a 3D printing model.
Compared to the conventional group, the 3D model-assisted group provide successful intervention and reduce operation, instrumentation time and the fluoroscopy usage with less blood loss. Performing 3D-assisted surgery helps the quality of reduction during the surgery and stability of internal fixation to protect achieved reduction at follow-up more succesfully.
本研究旨在比较传统手术与三维（3D）模型辅助手术治疗跟骨骨折的效果。
共纳入 37 例单侧跟骨骨折患者，随机分为常规手术组（n=19）和 3D 模型辅助手术组（n=18）。分别测量术前、术后及末次随访时的 Bohler 角和 Gissane 角、跟骨宽度和跟骨关节面高度。记录两组的手术时间、失血量、透视次数和内固定时间。最后，采用美国足踝外科协会（AOFAS）评分评估随访结果。采用问卷调查的方式了解住院医师对 3D 模型的看法。
3D 模型辅助手术组的手术时间、失血量、透视次数和内固定时间分别为 83.3±4.6 分钟、83.6±4.6ml、6.8±1.4 次和 13.0±0.8 周，常规手术组分别为 130.0±5.8 分钟、105.1±5.6 分钟、11.7±1.5 次和 22.2±2.4 周（p<0.0001）。两组术后的 Bohler 角、Gissane 角、跟骨宽度和跟骨关节面高度均显著恢复（p<0.0001）。3D 模型辅助组在恢复和保护跟骨关节面高度的矫正方面明显更成功（p<0.0001）。末次随访时，根据术后获得的测量值，两组间在跟骨关节面高度（p<0.001）、跟骨宽度（p<0.0001）和 Bohler 角（p=0.017）的变化量方面存在显著差异。末次随访时，两组 AOFAS 评分无显著差异。住院医师对 3D 打印模型的使用表示高度满意。
与常规组相比，3D 模型辅助组的手术干预更成功，可减少手术时间、内固定时间和透视次数，减少失血量。3D 辅助手术有助于提高术中复位质量和内固定稳定性，从而更好地保护术后获得的复位。
