摘要
目的比较跗骨窦切口联合/不联合3D打印治疗SandersⅡ型/Ⅲ型跟骨骨折的疗效并探讨联合3D打印技术的作用。方法回顾性分析2018年1月至2022年7月烟台市烟台山医院骨科采用跗骨窦切口治疗的88例SandersⅡ型/Ⅲ型跟骨骨折患者资料,其中男57例,女31例;年龄19~74岁。SandersⅡ型39足,SandersⅢ型49足。采用跗骨窦切口联合3D打印技术(3D打印组)治疗45例(45足),采用传统跗骨窦切口不联合3D打印(传统组)治疗43例(43足)。比较两组手术时间、切口大小、术中出血量、术中透视次数、骨折复位质量、术后切口并发症、距下关节僵硬情况、术后第3天和末次随访(术后12月)疼痛视觉模拟评分(VAS)、末次随访美国足踝外科协会踝与后足评分(AOFAS)。结果3D打印组的手术时间、切口大小、术中出血量、术中透视次数、术后第3天VAS评分分别为(53.2±9.4)min、(48.3±8.2)mm、(47.2±11.0)ml、(9.00±2.6)次、(1.80±0.82)分,均低于传统组的(86.2±11.7)min、(62.2±4.6)mm、(55.0±16.6)ml、(16.6±4.3)次、(2.32±1.20)分(均P<0.05)。3D打印组的骨折复位优良率、术后切口甲级愈合率分别为93.3%(42/45)、91.1%(41/45),高于传统组的65.1%(28/43)、79.1%(34/43),距下关节僵硬率为8.9%(4/45)低于传统组的21.6%(11/43)(均P<0.05)。末次随访时3D打印组和传统组的VAS评分分别为(1.30±0.76)分和(2.87±1.06)分,组间比较差异无统计学意义(P>0.05);3D打印组的AOFAS评分高于传统组[(90.56±4.84)分比(86.66±6.45)分,P<0.01)]。结论与传统跗骨窦切口治疗SandersⅡ型/Ⅲ型跟骨骨折相比,联合3D打印技术有助于改善手术过程和术后疗效。
Objective To compare the therapeutic effects of the Sinus Tarsi Approach combined with 3D printing technology and traditional Sinus Tarsi Approach in the treatment of Sanders typeⅡ/Ⅲcalcaneal fractures and explore the role of combined 3D printing technology.Methods The data of 88 Sanders typeⅡ/Ⅲcalcaneal fractures treated with the Sinus Tarsi Approach in orthopedics department of Yantaishan Hospital from January 2018 to July 2022 were retrospectively analyzed,including 57 males and 31 females;Age:19-74 years old.SandersⅡtype 39 feet,SandersⅢtype 49 feet.45 cases(45 feet)were treated with the Sinus Tarsi Approach combined with 3D printing technology(3D printing group),and 43 cases(43 feet)were treated with traditional Sinus Tarsi Approach(traditional group).The operative time,incision size,intraoperative bleeding,intraoperative fluoroscopy frequency,and fracture reduction quality,postoperative incision complications,the visual analogy scale(VAS)and the American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot scale at the third and last follow-up after surgery.Results The operative time,incision size,intraoperative bleeding,and intraoperative fluoroscopy frequency in the 3D printing group were(53.2±9.4)min,(48.3±8.2)mm,(47.2±11.0)ml,and(9.0±2.6)times,respectively,compared to(86.2±11.7)min,(62.2±4.6)mm,(55.0±16.6)ml,and(16.6±4.3)times in the traditional group,with statistically significant differences(all P<0.05);The excellent and good rate of fracture reduction in the combined 3D printing group and the traditional group were 93.3%(42/45)and 65.1%(28/43),respectively,with a statistically significant difference between the two groups(P<0.05);The rate of postoperative incision grade A healing in the 3D printing group and the traditional group was 91.1%(41/45)and 79.1%(34/43),respectively,with a statistically significant difference between the two groups(P<0.05);The rate of subtalar joint stiffness was 8.9%(4/45)and 16.3%(11/43)respectively,with a statistically significant difference between the two groups(P<0.05);The VAS scores of the 3D printing group and the traditional group on the 3rd day after surgery were(1.80±0.82)and(2.32±1.20),respectively,with a statistically significant difference between the two groups(P<0.05);At the last follow-up,the VAS scores of the 3D printing group and the traditional group were(1.30±0.76)and(2.87±1.06),respectively,with no significant difference between the two groups(P>0.05);At the last follow-up,the AOFAS scores of the 3D printing group and the traditional group were(90.56±4.84)and(86.66±6.45),respectively,with a statistically significant difference(P<0.01).Conclusion Compared with traditional Sinus Tarsi Approach in the treatment of Sanders typeⅡ/Ⅲcalcaneal fractures,the combination of 3D printing technology can improve the surgical process and postoperative efficacy.
作者
曲文庆
孙涛
张瑞东
宋雨
袁宇
刘子章
蔄元鹏
常黎明
Qu Wenqing;Sun Tao;Zhang Ruidong;Song Yu;Yuan Yu;Liu Zizhang;Man Yuanpeng;Chang Liming(Department of Orthopedics,Yantaishan Hospital,Yantai Key Laboratory for Repair and Reconstruction of Bone and Joint,Yantai 264003,China)
出处
《中华生物医学工程杂志》
CAS
2023年第5期524-530,共7页
Chinese Journal of Biomedical Engineering
基金
山东省重点研发计划项目(2016GSF201112)
山东省医药卫生科技发展计划项目(202004070458)。
关键词
3D打印技术
跟骨
骨折
跗骨窦入路
3D printing technology
Calcaneus
Fractures,bone
Sinus Tarsi Approach
