多层螺旋CT三维重建辅助3D打印技术对复杂髋臼骨折手术的应用价值研究

Research on application value of multislice spiral computed tomography three-dimensional reconstruction assisting 3D printing technique in complex acetabulum fracture surgery

摘要:

目的 分析多层螺旋CT（MSCT）三维重建辅助3D打印技术对复杂髋臼骨折手术的应用价值。方法 回顾性分析2017年4月—2019年3月大理大学第一附属医院83例复杂髋臼骨折患者的临床资料，其中以MSCT三维重建辅助3D打印技术行术前计划的38例为指导组，以传统方法行术前计划的45例为常规组。记录两组患者手术指标，评估骨盆、髋臼复位质量以及骨盆、髋关节功能恢复情况，并统计术后不良事件。结果 两组患者术中出血量、手术时间、术中透视时间及骨折愈合时间比较，差异有统计学意义（P <0.05），指导组较常规组术中出血量减少，指导组手术时间、术中透视时间及骨折愈合时间较常规组缩短。两组骨盆复位优良率均超过80%，髋臼实现解剖复位、满意复位者比例均超过85%，但两组骨盆及髋臼复位质量比较，差异无统计学意义（P >0.05）。与术前比较，两组术后3个月、6个月Majeed骨盆量化评分、Harris髋关节评分均升高（P <0.05），指导组术后3个月两项评分高于常规组（P <0.05），而术后6个月未见差异（P <0.05）。指导组、常规组患者均获得随访，期间两组不良事件发生率比较，差异无统计学意义（P >0.05）。结论 采用MSCT三维重建辅助3D打印技术进行术前指导，可使复杂髋臼骨折手术更具个性化，可减少术中出血量，缩短手术时间和透视时间，加快骨折愈合及骨盆、髋关节功能恢复。

关键词:髋臼骨折;多层螺旋CT;三维重建;3D打印技术;手术指导

Abstract:

Objective To analyze guiding roles of multislice spiral computed tomography (MSCT) three-dimensional reconstruction assisting 3D printing technique in complex acetabulum fracture (AF) surgery.Methods The clinical data of 83 patients with complex AF in orthopedics department of the hospital from April 2017 to March 2019 were retrospectively analyzed. Among them, 38 cases who underwent preoperative planning with MSCT three-dimensional reconstruction assisting 3D printing technique were enrolled as steering group, while 45 cases who underwent preoperative planning with traditional method were enrolled as routine group. The surgical indexes of the two groups were recorded. The reduction quality of pelvis and acetabulum, and function recovery of pelvis and hip joint were evaluated. The quality of pelvic and acetabular reduction, and the functional recovery of pelvic and hip joints were evaluated. The adverse events after operation were counted.Results Compared with routine group, intraoperative blood loss was significantly less in steering group, operation time, intraoperative fluoroscopy time and fracture healing time were significantly shorter (P < 0.05). The good rates of pelvic reduction in both groups were both higher than 80%. The proportions of acetabulum anatomical reduction and satisfactory reduction were both higher than 85%. However, there was no significant difference in reduction quality of pelvis or acetabulum between the two groups (P > 0.05). Compared with those before surgery, scores of Majeed pelvic quantification and Harris hip in both groups were significantly increased at 3 months and 6 months after surgery (P < 0.05). At 3 months after surgery, the above two scores in steering group were higher than those in routine group (P < 0.05), while there was no significant difference between the two groups at 6 months after surgery (P > 0.05). Patients in the steering group and routine group were followed up, and the difference in adverse event rates between steering group and routine group during the period was not statistically significant (χ² = 0.613, P = 0.434).Conclusion The application of MSCT three-dimensional reconstruction assisting 3D printing technique for preoperative guidance can make complex AF surgery more personalized, thus shortening operation time and fluoroscopy time, reducing intraoperative blood loss, accelerating fracture healing, pelvic, and hip function recovery.

Key words:acetabulum fracture;multislice spiral computed tomography;three-dimensional reconstruction;3D printing technique;surgical guidance