摘要目的 探讨3D打印个性化体外导板辅助经皮微创置钉治疗骨盆、髋臼骨折的有效性和安全性. 方法 回顾性分析2016年6月至2018年2月期间华中科技大学同济医学院附属协和医院骨科采用经皮微创置钉治疗的39例骨盆、髋臼骨折患者资料.根据是否使用3D打印个性化体外导板分为两组:体外导板组21例,男14例,女7例;年龄为(46.3±18.2)岁;骨盆骨折17例,髋臼骨折4例.徒手置钉组18例,男12例,女6例;年龄为(43.8±12.2)岁;骨盆骨折14例,髋臼骨折4例.记录并比较两组患者的手术时间、术中累计透视次数、导针调整次数、骨折复位质量、螺钉穿出率、功能评定结果及并发症发生情况等. 结果 39例患者术后获9～13个月(平均11.6个月)随访.体外导板组和徒手置钉组分别置入42、35枚螺钉.体外导板组患者的手术时间[(43.8 ±22.2) min]、术中累计透视次数[(29.6±10.7)次]、导针调整次数[(1.8±1.2)次]显著少于徒手置钉组患者[(73.8±22.6) min、(54.6±16.5)次、(9.8±2.8)次],差异均有统计学意义(P＜0.05).两组患者的螺钉穿出率、骨折复位满意率、末次随访时Majeed骨盆功能评分结果及改良Merle d'Aubigné & Postel评分结果比较差异均无统计学意义(P＞0.05).徒手置钉组1例患者术后出现单侧足背麻木,3个月时症状消失. 结论 3D打印个性化体外导板辅助置钉能减少术中透视次数、缩短手术时间、提高置钉精度,为骨盆、髋臼骨折微创治疗提供了一种新思路.

abstractsObjective To evaluate the efficacy and safety of 3D printing patient-specific external guide template in assisting minimally invasive screwing for treatment of pelvic and acetabular fractures.Methods The clinical and follow-up data of 39 pelvic or acetabular fractures were retrospectively analyzed which had been treated from June 2016 to February 2018 at Department of Orthopaedics,Wuhan Union Hospital.The patients were divided into a template group and a freehand group.In the template group,there were 14 men and 7 women with an age of 46.3 ± 18.2 years and 17 pelvic fractures and 4 acetabular fractures;in the freehand group,there were 12 men and 6 women with an age of 43.8 ± 12.2 years and 14 pelvic fractures and 4 acetabular fractures.The 2 groups were compared in terms of operation time,fluoroscopic frequency,guide wire adjustments,fracture reduction,screw penetration rate,function evaluation and adverse events.Results All the 39 patients were followed up for 9 to 13 months (average,11.6 months).A total of 42 screws were placed in the template group and 35 screws in the freehand group.The values of operation time (43.8 ± 22.2 min),fluoroscopic frequency (29.6 ± 10.7 times) and guide wire adjustments (1.8 ± 1.2 times) in the external guide template group were all significantly lower than those in the freehand group (73.8 ±22.6 min,54.6 ± 16.5 times and 9.8 ±2.8 times,respectively) (P ＜0.05).There were no significant differences between the 2 groups in screw penetration rate,rate of satisfactory reduction,Majeed scores for pelvic function or modified Merle d'Aubigné scores at the last follow-ups (P ＞ 0.05).One case in the freehand group experienced numbness after operation on unilateral dorsi pedis which disappeared at 3-month follow-up.Conclusion The 3D printing patient-specific external guide template can reduce fluoroscopic frequency,save operation time and improve accuracy of screw insertion,providing a new means for minimally invasive treatment of pelvis and acetabular fractures.