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3D打印技术辅助肩峰前外侧入路手术治疗Neer3、4型肱骨近端骨折的疗效

Efficacy of 3D printing assisted anterolateral acromial approach in the treatment of Neer type 3, 4 of proximal humeral fractures

    摘要
  • 摘要:
    目的 观察3D打印技术辅助肩峰前外侧入路手术内固定治疗Neer 3、4型肱骨近端骨折(PHF)的临床效果。
    方法 选取行肩峰前外侧入路手术治疗的Neer 3、4型PHF患者43例, 随机分为对照组20例和3D打印组23例。比较2组手术时间、术中出血量、透视次数、解剖复位率、术后引流量。随访12个月, 记录并比较2组肩关节Neer评分和肩关节功能评分(CMS)。
    结果 3D打印组的手术时间、术中出血量、术后引流量和C臂机透视次数均短于或少于对照组, 差异有统计学意义(P < 0.05)。3D打印组骨折愈合时间和术后12个月疼痛评分短于或低于对照组, 差异有统计学意义(P < 0.05)。3D打印组术后3、12个月Neer评分及术后12个月肌力、日常活动和关节活动范围评分高于对照组, 差异有统计学意义(P < 0.05)。术后3个月, 3D打印组肱骨头丢失高度、肱骨头内翻角小于对照组, 肱骨颈干角大于对照组, 差异有统计学意义(P < 0.05)。3D打印组出现1例(4.35%)肱骨头坏死, 对照组出现3例(15.00%)肱骨头坏死, 其余患者骨折均愈合。
    结论 应用3D打印技术辅助肩峰前外侧入路手术治疗Neer 3、4型PHF, 可显著缩短手术时间、骨折愈合时间, 减少术中出血量, 减少对肱骨近端血运的破坏, 显著改善患者肩关节功能。

     

    Abstract:
    Objective To observe the clinical effect of 3D printing assisted anterolateral acromion approach in treatment of Neer type 3 and 4 of proximal humerus fractures (PHF).
    Methods  A total of 43 patients with Neer type 3 and 4 of PHF who underwent anterolateral acromial approach were selected and randomly divided into control group (n=20) and 3D printing group (n=23). Operation time, intraoperative blood loss, fluoroscopy times, anatomic reduction rate and postoperative drainage volume were compared between the two groups. Follow-up for 12 months, the shoulder Neer score and Constant-Murley score (CMS) were recorded and compared between the two groups.
    Results  The operative time, intraoperative blood loss, postoperative drainage volume and C-arm fluoroscopy times in the 3D printing group were significantly shorter or less than those in the control group (P < 0.05). Fracture healing time and 12 months postoperative pain score in the 3D printing group were significantly shorter or lower than those in the control group (P < 0.05). Neer scores of 3 and 12 months after surgery and muscle strength, daily activity and joint range of motion score 12 months after surgery in the 3D printing group were significantly higher than those of the control group (P < 0.05). Three months after surgery, the humeral head loss height and the humeral head varus angle in the 3D printing group were significantly lower, while the humeral neck trunk angle was significantly higher than that in the control group (P < 0.05). There was 1 case (4.35%) of humeral head necrosis in the 3D printing group, and 3 cases (15.00%) in the control group, and the fractures of the rest patients were all healed.
    Conclusion  The application of 3D printing technology to assist the anterolateral acromial approach in treatment of Neer type 3 and 4 of PHF can significantly shorten the operation time and fracture healing time, reduce intraoperative blood loss, and reduce the damage to the proximal humerus blood supply, and significantly improve the shoulder joint function of patients.

     

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