何藻鹏+李卫+刘金伟+郑玉东+曾迪藩+刘东波

【摘要】 目的 探讨3D打印技术在复杂跟骨骨折中的应用方法及效果。方法 72例（84足）复杂跟骨骨折患者， 按床位单双号将患者分为对照组和3D组， 各36例（42足）。两组患者均进行术前常规CT检查， 并进行跟骨切开复位内固定术。其中对照组患者直接根据X线及CT二维图像进行手术， 3D组患者进行数字化重建、模拟复位并打印跟骨3D模型， 术前钢板预塑形、设计个性化方案再行手术治疗。观察两组患者手术情况、治疗效果以及并發症发生情况。结果 3D组患者手术时间、术中出血量均优于对照组， C臂X线暴露风险小于对照组， 差异具有统计学意义（P<0.05）。3D组优良率为92.86%， 高于对照组的76.19%， 差异具有统计学意义（P<0.05）。两组并发症发生率比较差异无统计学意义（P>0.05）。结论 3D打印技术在复杂跟骨骨折中应用效果较好， 可提前进行术前设计及模拟手术， 对手术起到辅助作用， 提高手术效果， 降低并发症， 值得临床应用及推广。

【关键词】 3D打印技术；跟骨骨折；模型；疗效

DOI：10.14163/j.cnki.11-5547/r.2017.09.022

Application of 3D printing technique in complex calcaneal fracture HE Zao-peng， LI Wei， LIU Jin-wei， et al. Department Three of Surgery， Foshan City Shunde District Lecong Hospital， Foshan 528315， China

【Abstract】 Objective To investigate application method and effect by 3D printing technique in complex calcaneal fracture. Methods A total of 72 patients （84 feet） with complex calcaneal fracture were divided by their bed number into control group and 3D group， with 36 cases （42 feet） in each group. Both groups received conventional preoperative CT examination and calcaneal open reduction internal fixation operation. The control group received operation in accordance with X-ray and CT two-dimensional diagram， and the 3D group received operation after digital reconstruction， reduction simulation， 3D calcaneal model printing， preoperative prefabricating plate， and individualized scheme. Observation was made on operation condition， curative effect and complications in the two groups. Results The 3D group had better operation time and intraoperative bleeding volume than the control group， and its C-arm X-ray exposure risk was lower than the control group. Their difference had statistical significance （P<0.05）. 3D group had higher good rate as 92.86% than 76.19% in the control group， and the difference had statistical significance （P<0.05）. There was no statistically significant difference of incidence of complications between the two groups （P>0.05）. Conclusion 3D printing technique shows excellent application effect in complex calcaneal fracture. It can provide preoperative design and operation simulation， along with assistant effect in operation. This method can improve operative effect and lower incidence of complications， and it is worth clinical application and promotion.

【Key words】 3D printing technique； Calcaneal fracture； Model； Curative effect

跟骨骨折是临床上常见的骨折类型， 约75%为关节内骨折。由于跟骨的解剖复杂性， 软组织覆盖较差， 因此跟骨骨折治疗较为棘手， 术后并发症多， 患者预后较差[1]。目前对于跟骨骨折的多采用手术治疗， 术前采用X线或CT扫描， 根据二维图像观察跟骨骨折情况， 结合医师经验， 设计手术方案[2]。因此在跟骨骨折患者手术前往往不能准确评估跟骨复位后状态、钢板形态、置钉位置与方向， 需要术中牵引、翘拨复位后根据C臂透视情况再行决定， 增加了手术时间与不确定性， 影响治疗效果[3]。目前随着影像……