CAJ | 학술논문

目的探讨术前3D打印技术模拟复杂骨盆骨折手术提高疗效的可行性. 方法回顾性分析2007年3月至2013年12月共收治的200例复杂骨盆骨折的患者资料,男147例,女53例;年龄19 ～ 62岁,平均35岁.骨折按Tile分型:B型78例,C型122例.其中73例患者术前采取CT三维重建、血管造影、3D打印快速成型、计算机模拟与个体化标本模拟手术,术中按术前计划手术(3D技术组);127例患者常规术前检查及手术(常规组).记录两组患者术中出血量、输血量、手术时间等,术后根据Matta等标准评定骨折复位质量. 结果所有患者术后获6个月至6年(平均24个月)随访.与常规组相比,3D技术组术中出血量、输血量少,手术时间缩短,手术并发症的发生率低,两组间差异均有统计学意义(P＜0.05).术后12个月根据Matta等标准评定骨折复位质量:3D技术组:优59例,良9例,可5例,优良率达93.2％;常规组:优69例,良36例,可18例,差4例,优良率达82.7％,两组间比较差异有统计学意义(P＜0.05).3D技术组与常规组分别出现切口浅表感染1例、3例,尿路感染2例、4例,深静脉血栓形成2例、5例,股外侧皮神经麻痹1例、3例.仅常规组出现腹股沟疝2例.无一例患者发生医源性损伤L6、S1神经根及坐骨神经损伤.结论血管造影、快速成型、计算机辅助的个体化3D打印技术术前模拟可提高复杂骨盆骨折的手术效率、减少术中出血量并降低手术并发症发生率.
목적 탐토술전3D타인기술모의복잡골분골절수술제고료효적가행성. 방법 회고성분석2007년3월지2013년12월공수치적200례복잡골분골절적환자자료,남147례,녀53례;년령19 ～ 62세,평균35세.골절안Tile분형:B형78례,C형122례.기중73례환자술전채취CT삼유중건、혈관조영、3D타인쾌속성형、계산궤모의여개체화표본모의수술,술중안술전계화수술(3D기술조);127례환자상규술전검사급수술(상규조).기록량조환자술중출혈량、수혈량、수술시간등,술후근거Matta등표준평정골절복위질량. 결과 소유환자술후획6개월지6년(평균24개월)수방.여상규조상비,3D기술조술중출혈량、수혈량소,수술시간축단,수술병발증적발생솔저,량조간차이균유통계학의의(P＜0.05).술후12개월근거Matta등표준평정골절복위질량:3D기술조:우59례,량9례,가5례,우량솔체93.2％;상규조:우69례,량36례,가18례,차4례,우량솔체82.7％,량조간비교차이유통계학의의(P＜0.05).3D기술조여상규조분별출현절구천표감염1례、3례,뇨로감염2례、4례,심정맥혈전형성2례、5례,고외측피신경마비1례、3례.부상규조출현복고구산2례.무일례환자발생의원성손상L6、S1신경근급좌골신경손상.결론 혈관조영、쾌속성형、계산궤보조적개체화3D타인기술술전모의가제고복잡골분골절적수술효솔、감소술중출혈량병강저수술병발증발생솔.
Objective To investigate the effect of application of 3D printing technology on the treatment of complicated pelvic fractures.Methods A retrospective analysis was performed of 200 complicated pelvic fractures at our department from March 2007 to December 2013.They were 147 men and 53 women,aged from 19 to 62 years (average,35 years).By the Tile classification,there were 78 cases of type B and 122 ones of type C.Of them,73 underwent CT 3D reconstruction,angiography,3D printing and rapid prototyping,individualized templating before surgery (3D group),and 127 underwent conventional CT scanning before surgery (control group).The intraoperative bleeding,blood transfusion and operation time were compared between the 2 groups.The fracture union was also compared according to the Matta criteria.Results The patients obtained follow-up from 6 months to 6 years (average,24 months).The 3D group had significantly less intraoperative bleeding,blood transfusion,operation time and operation-related complications than the control group (P ＜ 0.05).At 12 months postoperation,by the Matta criteria,the 3D group had 59 excellent,9 good and 5 fair cases,yielding an excellent to good rate of 93.2％ ; the control group had 69 excellent,36 good,18 fair and 4 poor cases,yielding an excellent to good rate of 82.7％.There was also a significant difference between the 2 groups (P ＜ 0.05).Respectively,there were one and 3 cases of superficial incision infection,2 and 4 cases of urinary tract infection,2 and 5 cases of deep vein thrombosis,and one and 3 cases of lateral femoral cutaneous nerve palsy in the 3D and control groups.Two cases of inguinal hernia occurred only in the control group.No iatrogenic injury to the nerve roots of L5 and S1 or sciatic nerve was found in either of the 2 groups.Conclusion Application of 3D printing technology along with angiography,rapid prototyping,and individualized templating before surgery can enhance operative efficacy,decrease intraoperative hemorrhage and operation-related complications in the treatment of complicated pelvic fractures.