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Title: [Application of three-dimensional printing in the operation of distal tibia fracture involving epiphyseal plate injury for teenagers].
Author: Zhao J, Ma Y, Han D, Jin Y.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2017 Oct 15; 31(10):1195-1199. PubMed ID: 29806320.
Abstract:
OBJECTIVE: To investigate the application value of three-dimensional (3-D) printing technology in the operation of distal tibia fracture involving epiphyseal plate injury for teenagers. METHODS: The retrospective analysis was conducted on the clinical data of 16 cases of children patients with distal tibia fracture involving epiphyseal plate injury undergoing the operation by using of 3-D printing technology between January 2014 and December 2015. There were 12 males and 4 females with an age of 9-14 years (mean, 12.8 years). The causes of injury included traffic accident injury in 9 cases, heavy pound injury in 3 cases, and sport injury in 4 cases. The time from injury to operation was 3-92 hours (mean, 25.8 hours). According to Salter-Harris typing standard, the typing for epiphyseal injury was classified as type Ⅱ in 11 cases, type Ⅲ in 4 cases, and type Ⅳ in 1 case. The thin slice CT scan on the affected limb was performed before operation, and the Mimics14.0 medical software was applied for the design and the 1∶1 fracture model was printed by the 3-D printer; the stimulation of operative reduction was made in the fracture model, and bone plate, Kirschner wire, and hollow screw with the appropriate size were chosen, then the complete operative approach and method were designed and the internal fixator regimen was chosen, then the practical operation was performed based on the preoperative design regimen. RESULTS: The operation time was 40-68 minutes (mean, 59.1 minutes); the intraoperative blood loss was 5-102 mL (mean, 35 mL); the intraoperative fluoroscopy times was 2-6 times (mean, 2.8 times). All the patiens were followed up 12-24 months (mean, 15 months). The fracture of 15 cases reached anatomic reduction, and 1 cases had no anatomic reduction with the displaced end less than 1 mm. All the fractures reached bony union with the healing time of 2-4 months (mean, 2.6 months). There was no deep vein thrombosis, premature epiphyseal closure and oblique, or uneven ankle surface occurred, and there was no complication such as osteomyelitis, varus or valgus of ankle joint, joint stiffness, traumatic arthritis. Helfet scores of ankle function were measured at 12 months after operation, the results were excellent in 15 cases and good in 1 case. The angulation of introversion and extroversion for the affected limb was (6.56±2.48)°, and the growth length was (4.44±2.31) mm, and there was no significant difference ( t=0.086, P=0.932; t=0.392, P=0.697) when compared with the uninjured side [(6.50±1.51)°, (4.69±1.08) mm]. CONCLUSION: As the assistive technology, 3-D printing technology has a certain clinical application value in improving the effectiveness of distal tibia fracture involving epiphyseal plate injury. 目的: 探讨 3-D 打印技术在青少年胫骨远端骨折累及骺板损伤手术中的应用价值。. 方法: 回顾分析 2014 年 1 月—2015 年 12 月采用 3-D 打印技术行手术治疗的 16 例胫骨远端骨折累及骺板损伤患儿临床资料。男 12 例，女 4 例；年龄 9～14 岁，平均 12.8 岁。致伤原因：交通事故伤 9 例，重物砸伤 3 例，运动伤 4 例。受伤至手术时间 3～92 h，平均 25.8 h。累及骺板的骨折按 Salter-Harris 进行分型：Ⅱ 型 11 例、Ⅲ 型 4 例、Ⅵ 型 1 例。术前对患肢行薄层 CT 扫描，应用 Mimics14.0 医学软件进行设计，并使用 3-D 打印机打印出 1∶1 骨折模型；在骨折模型上模拟手术复位操作并选择合适大小的接骨板、克氏针、空心螺钉，设计完整的手术入路、手术方式、选择内固定物，根据术前设计方案进行实际手术。. 结果: 手术时间 40～68 min，平均 59.1 min；术中出血量 5～102 mL，平均 35 mL；术中透视次数 2～6 次，平均 2.8 次。16 例患儿均获随访，随访时间 12～24 个月，平均 15 个月。其中 15 例患儿骨折达解剖复位，1 例骨折未解剖复位，断端移位<1 mm。术后患儿骨折均达骨性愈合，愈合时间 2～4 个月，平均 2.6 个月。均无下肢深静脉血栓形成、骨骺早闭、踝关节面倾斜或不平发生，未并发骨髓炎，无踝关节内外翻畸形、关节僵直、创伤性关节炎等并发症发生。术后 12 个月行患肢踝关节功能 Helfet 评分，获优 15 例，良 1 例。患侧内外翻成角为（6.56±2.48）°，生长长度为（4.44±2.31）mm，与健侧[（6.50±1.51）°、（4.69±1.08）mm]比较差异均无统计学意义（ t=0.086， P=0.932； t=0.392， P=0.697）。. 结论: 3-D 打印技术作为辅助技术，对改善胫骨远端骨折累及骺板损伤手术效果具有一定的临床应用价值。.

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