Application effect of three dimensional printing in the treatment of terrible triad of the elbow
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摘要:
目的评估3D打印技术在肘关节恐怖三联征治疗中的应用效果。 方法选取2017年4月~2019年1月我院收治的肘关节恐怖三联征患者40例为研究对象，采用随机数字表法分为观察组、对照组各20例，对照组经X线、CT平扫+三维重建检查完成术前设计，观察组在应用X线、CT平扫+三维重建基础上，利用有限元软件mimics及3D打印技术将骨折复位和内固定植入具象化，完成术前设计，两组均经缝合铆钉的方式修补内侧与外侧韧带复合体。对比两组手术疗效、手术前后肘关节功能（Broberg-Morrev肘关节功能评分）、疼痛度[疼痛视觉模拟评分（VAS）]、术后并发症发生率。 结果观察组手术时间、术中出血量、术中透视次数、骨折愈合时间短/少于对照组（P<0.05）；观察组术后3、6、9月Broberg-Morrev评分高于对照组（P<0.05）；观察组术后1、3、6月VAS评分低于对照组（P<0.05）；观察组术后9月内并发症发生率与对照组差异无统计学意义（P>0.05）。 结论3D打印技术应用于肘关节恐怖三联征治疗中，可明显提高手术疗效，促进患者术后肘关节功能恢复，减轻疼痛，不会明显增加并发症风险，值得在临床推广实践。 -
关键词:
- 3D打印技术 /
- 肘关节恐怖三联征 /
- mimics /
- Broberg-Morrev评分
Abstract:ObjectiveTo evaluate the application effect of three dimensional (3D) printing in the treatment of terrible triad of the elbow. MethodsForty patients with terrible triad of the elbow who were admitted to the hospital between April 2017 and January 2019 were selected as subjects. They were randomly divided into the observation group and the control group, 20 cases in each group. For the control group, preoperative design was completed through X-ray, CT plain scan and 3D reconstruction. The finite element software mimics and 3D printing were applied for the observation group to visualize fracture reduction and internal fixation, by which preoperative design was completed. All the medial and lateral ligament complexes of both groups were repaired with suture rivets. The surgical effect, elbow function (Broberg-Morrev elbow function scores) and pain degree [pain visual analogue scale (VAS) scores] before and after surgery, and incidence of postoperative complications were compared between the two groups. ResultsThe operation time, amount of intraoperative blood loss, frequency of intraoperative fluoroscopy and fracture healing time of the observation group were shorter or less than those of the control group (P<0.05). Broberg-Morrev scores of the observation group at 3 months, 6 months and 9 months after surgery were higher than those of the control group (P<0.05). VAS scores of observation group at 1 month, 3 months and 6 months after surgery were lower than those of the control group (P<0.05). There was no significant difference in incidence rate of complications between the two groups within 9 months after surgery (P>0.05). ConclusionThe application of 3D printing in the treatment of terrible triad of the elbow can improve the surgical effect, promote postoperative recovery of elbow function, and alleviate pain, without significantly increasing the risk of complications. -
Key words:
- three dimensional printing /
- terrible triad of the elbow /
- mimics /
- Broberg-Morrev score
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表 1 两组一般资料比较[n=20, n（%）]
Table 1. Comparison of general data in two groups
一般资料 观察组 对照组 χ2/t P 性别 男 11（55.00） 10（50.00） 0.100 0.752 女 9（45.00） 10（50.00） 年龄（岁，Mean±SD） 34.18±3.57 33.97±3.45 0.189 0.851 致伤原因 摔伤 10（50.00） 11（55.00） 0.138 0.933 交通事故伤 6（30.00） 5（25.00） 重物砸伤 4（20.00） 4（20.00） Regan-Morreyt分型 Ⅰ型 7（35.00） 8（40.00） 0.158 0.924 Ⅱ型 6（30.00） 5（25.00） Ⅲ型 7（35.00） 7（35.00） 
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表 2 两组手术疗效指标比较（n=20, Mean±SD）
Table 2. Comparison of surgical efficacy index between two groups
组别 观察组 对照组 t P 手术时间（min） 74.87±8.52 81.26±8.29 2.404 0.021 术中出血量（mL） 78.51±7.93 100.54±10.25 7.602 <0.001 术中透视次数（次） 2.41±0.29 3.10±0.34 6.905 <0.001 骨折愈合时间（月） 2.85±0.29 3.11±0.32 2.692 0.01
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表 3 两组Broberg-Morrev评分比较（分，n=20, Mean±SD）
Table 3. Comparison of Broberg-Morrev scores between two groups
时间 观察组 对照组 F P 术前 67.15±6.84 68.02±6.75 F交互=48.572,
F组间=33.152,
F时点=7.659P交互<0.001，
P组间<0.001，
P时点=0.002术后3月 81.43±8.23*# 75.42±7.62* 术后6月 85.41±8.27*# 79.21±8.02* 术后9月 88.35±8.86*# 83.56±8.49* *P<0.05 vs 术前；#P<0.05 vs 对照组.
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表 4 两组VAS评分比较（分，n=20, Mean±SD）
Table 4. Comparison of VAS scores between two groups
时间 观察组 对照组 F P 术前 3.26±0.34 3.21±0.33 F交互=48.572,
F组间=33.152,
F时点=7.659P交互<0.001，
P组间<0.001，
P时点=0.002术后1月 2.05±0.23*# 2.44±0.27* 术后3月 1.85±0.19*# 2.14±0.23* 术后6月 1.57±0.18*# 1.89±0.20* *P<0.05 vs 术前；#P<0.05 vs 对照组.
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表 5 两组并发症发生率比较 [n=20，n（%）]
Table 5. Comparison of the incidence of complications between two groups
并发症 观察组 对照组 连续校正χ2 P 感染 1（5.00） 2（10.00） 0.365 0.546 关节面不对合 0（0.00） 3（15.00） - 0.231 骨化性肌炎 1（5.00） 1（5.00） 0.526 0.468 创伤性关节炎 2（10.00） 3（15.00） 0.229 0.632
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