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目的探讨3-D打印技术在青少年胫骨远端骨折累及骺板损伤手术中的应用价值。方法回顾分析2014年1月—2015年12月采用3-D打印技术行手术治疗的16例胫骨远端骨折累及骺板损伤患儿临床资料。男12例,女4例;年龄9~14岁,平均12.8岁。致伤原因:交通事故伤9例,重物砸伤3例,运动伤4例。受伤至手术时间3~92 h,平均25.8 h。累及骺板的骨折按Salter-Harris进行分型:Ⅱ型11例、Ⅲ型4例、Ⅵ型1例。术前对患肢行薄层CT扫描,应用Mimics14.0医学软件进行设计,并使用3-D打印机打印出1∶1骨折模型;在骨折模型上模拟手术复位操作并选择合适大小的接骨板、克氏针、空心螺钉,设计完整的手术入路、手术方式、选择内固定物,根据术前设计方案进行实际手术。结果手术时间40~68 min,平均59.1 min;术中出血量5~102 mL,平均35 mL;术中透视次数2~6次,平均2.8次。16例患儿均获随访,随访时间12~24个月,平均15个月。其中15例患儿骨折达解剖复位,1例骨折未解剖复位,断端移位<1 mm。术后患儿骨折均达骨性愈合,愈合时间2~4个月,平均2.6个月。均无下肢深静脉血栓形成、骨骺早闭、踝关节面倾斜或不平发生,未并发骨髓炎,无踝关节内外翻畸形、关节僵直、创伤性关节炎等并发症发生。术后12个月行患肢踝关节功能Helfet评分,获优15例,良1例。患侧内外翻成角为(6.56±2.48)°,生长长度为(4.44±2.31)mm,与健侧[(6.50±1.51)°、(4.69±1.08)mm]比较差异均无统计学意义(t=0.086,P=0.932;t=0.392,P=0.697)。结论 3-D打印技术作为辅助技术,对改善胫骨远端骨折累及骺板损伤手术效果具有一定的临床应用价值。
Objective To investigate the application of 3-D printing technology in the surgical treatment of distal tibial fractures involving the epiphyseal plate in adolescents. Methods The clinical data of 16 cases of distal tibial fractures involving epiphyseal plate injury treated by 3-D printing technique from January 2014 to December 2015 were analyzed retrospectively. There were 12 males and 4 females, aged from 9 to 14 years with an average age of 12.8 years. Cause of injury: traffic accident in 9 cases, 3 cases of heavy injury, sports injury in 4 cases. Injured to surgery time 3 ~ 92 h, an average of 25.8 h. Fractures involving the epiphyseal plate were typed according to Salter-Harris: type II 11, type III 4, type VI 1. Thinning CT scan of preoperative limbs, using Mimics14.0 medical software design, and use the 3-D printer to print the 1: 1 fracture model; in the fracture model to simulate the surgical reduction and select the appropriate size plate, Kirschner wire, hollow screw, a complete design of the surgical approach, surgical methods, the choice of internal fixation, according to the preoperative design of the actual operation. Results The operation time ranged from 40 to 68 minutes (mean 59.1 minutes). The intraoperative blood loss was from 5 to 102 mL (average 35 mL). The number of fluoroscopy was 2 to 6 times (average 2.8). All 16 children were followed up for 12-24 months (average 15 months). Among them, 15 cases were fractured for anatomic reduction and 1 case for fracture was not anatomically resected. The fracture displacement was less than 1 mm. Postoperative fractures in children up to bone healing, healing time 2 to 4 months, an average of 2.6 months. No deep venous thrombosis of lower extremities, early epiphyseal epiphyseal, ankle surface tilt or uneven incidence of uncomplicated osteomyelitis, ankle valgus deformity, joint stiffness, traumatic arthritis and other complications. Twelve months after operation, the ankle joint function Helfet score was obtained, which was excellent in 15 cases and good in 1 case. The ipsilateral and valgus angulations were (6.56 ± 2.48) ° and (4.44 ± 2.31) mm in length, which were not significantly different from those in contralateral (6.50 ± 1.51) and (4.69 ± 1.08) mm t = 0.086, P = 0.932; t = 0.392, P = 0.697). Conclusion 3-D printing technology as an adjunctive technique has some clinical value in improving the surgical effect of epiphyseal plate injury in distal tibial fractures.