CAJ | 학술논문

目的探讨快速成型(RP)技术对肱骨近端复杂骨折的诊断及治疗的辅助作用. 方法回顾性分析2010年1月至2014年1月收治的18例肱骨近端粉碎性骨折患者资料,男7例,女11例;年龄39 ～ 78岁,平均62岁.所有患者均为闭合性新鲜骨折,其中10例患者经三维CT扫描并采用RP制备骨折模型,然后通过模型确定骨折分型(骨折Neer分型:三部分骨折7例,四部分骨折3例),指导手术治疗(3D技术组);8例患者常规行切开复位内固定术治疗(常规组)(骨折Neer分型:三部分骨折6例,四部分骨折2例).比较两组患者的手术时间、术中出血量等.术后6个月采用Neer评价标准评定疗效. 结果通过对1∶1等大的RP模型分析研究,明确骨折类型后均顺利完成术前制定的手术方案.3D技术组患者的手术时间(平均1.1h)及术中出血量(平均190 mL)均少于常规组患者(1.5 h、240 mL).所有患者术后获7～23个月(平均16个月)随访.骨折愈合时间3～5个月(平均4.3个月).术后6个月采用Neer评价标准评定疗效:3D技术组:优5例,良4例,可1例;常规组:优3例,良4例,可1例. 结论 1∶1的RP模型能直观、准确地展现骨折伤情,使手术方案具体化、个体化,可减少术中出血量并缩短手术时间,提高疗效.
목적 탐토쾌속성형(RP)기술대굉골근단복잡골절적진단급치료적보조작용. 방법 회고성분석2010년1월지2014년1월수치적18례굉골근단분쇄성골절환자자료,남7례,녀11례;년령39 ～ 78세,평균62세.소유환자균위폐합성신선골절,기중10례환자경삼유CT소묘병채용RP제비골절모형,연후통과모형학정골절분형(골절Neer분형:삼부분골절7례,사부분골절3례),지도수술치료(3D기술조);8례환자상규행절개복위내고정술치료(상규조)(골절Neer분형:삼부분골절6례,사부분골절2례).비교량조환자적수술시간、술중출혈량등.술후6개월채용Neer평개표준평정료효. 결과 통과대1∶1등대적RP모형분석연구,명학골절류형후균순리완성술전제정적수술방안.3D기술조환자적수술시간(평균1.1h)급술중출혈량(평균190 mL)균소우상규조환자(1.5 h、240 mL).소유환자술후획7～23개월(평균16개월)수방.골절유합시간3～5개월(평균4.3개월).술후6개월채용Neer평개표준평정료효:3D기술조:우5례,량4례,가1례;상규조:우3례,량4례,가1례. 결론 1∶1적RP모형능직관、준학지전현골절상정,사수술방안구체화、개체화,가감소술중출혈량병축단수술시간,제고료효.
Objective To explore the auxiliary role of rapid prototyping (RP) technique in diagnosis and operation design for complex fractures of proximal humerus.Methods A retrospective study was conducted to analyze the 18 patients with complex fracture of proximal humerus who had been treated by authors from January 2010 to January 2014.They were 7 men and 11 women,aged from 39 to 78 years (average,62 years).All fractures were fresh and closed.Ten patients underwent three-dimensional CT scan and RP was used to prepare their fracture models which were used to guide their operation design (3D group).By Neer classification,7 of them had three-part fractures and 3 four-part fractures.Another 8 patients received conventional open reduction and internal fixation (control group).By Neer classification,6 of them had three-part fractures and 2 four-part fractures.The 2 groups were compared in terms of operation time and intraoperative bleeding.Their outcomes were assessed using Neer evaluation criteria 6 months postoperation.Results The RP fracture models of 1 ∶ 1 ratio facilitated classification of the fractures and the following operation design.The 3D group incurred less operation time (1.1 hours on average) and bleeding (190 mL on average) than the control group (1.5 hours and 240 mL).All the patients were followed up for 7 to 23 months (16 months on average).Fractures healed after 3 to 5 months (4.3 months on average).Neer evaluation 6 months postoperation showed 5 excellent cases,4 good cases and one fair case in the 3D group while 3 excellent cases,4 good cases and one fair case in the control group.Conclusions The fracture models of 1∶1 ratio manufactured by RP technique may help surgeons to gain accurate and visualized knowledge of the fracture to be treated.Consequently their surgical plan can be more specific and more individualized with the aid of RP models.Therefore,operation time and bleeding can be reduced to improve the curative effect.