腹股沟入路与Stoppa入路在应用3D打印导板治疗髋臼骨折的对比研究

Comparative Study of Inguinal Approach and Stoppa Approach in the Treatment of Acetabular Fractures with 3D Printing Guide Plat

摘要: 目的：比较腹股沟入路与Stoppa入路在应用3D打印导板治疗髋臼骨折的效果，寻找最佳的手术入路方案。方法：本研究选取自2012年1月~2019年1月入我院创伤外科的142例患者，所有患者均采用术前3D打印技术模拟患者髋臼骨折的损伤类型，术前根据骨折的类型对钢板进行预先塑形或者直接定制个体化钢板，根据手术入路随机分成2组，其中腹股沟入路组68例，男性46例，女性22例；Stoppa入路组74例，男性51例，女性23例。收集患者的CT + 三维重建资料和髂血管CTA的数据，以DICOM形式保存，导入Mimic软件中，进行软件处理，对髋臼骨折进行还原。同时采用3ds Max 2013软件，对骨折的复位，螺钉的位置和大小进行设计。统计并记录手术显露时间、切口长度、术中出血量；利用Matta影像学评分评价髋臼骨折复位质量，根据髋关节Postel评分评价髋关节功能。结果：2组患者一般基准资料比较无统计学差异(P > 0.05)。Mimic软件模拟骨盆髋臼骨折，并且利用Mimic软件模拟钢板安放，Stoppa入路组的手术切口长度要比腹股沟入路组小，手术暴露时间短，术中失血量少，麻醉时间和苏醒时间短，具有统计学差异(P < 0.05)。2组患者的Matta影像学评分评价髋臼骨折复位质量无统计学意义(P > 0.05)。2组患者的髋关节Postel评分评价术后髋关节功能无统计学意义(P > 0.05)。2组患者术后并发症比较中，Stoppa入路组要明显低于腹股沟入路组，具有统计学意义(P < 0.05)。结论：3D打印导板下的钢板可以做到解剖复位和坚强内固定，Stoppa入路减少软组织损伤，降低术中出血量，更适用于3D打印导板下的钢板固定髋臼骨折。

Abstract: Objective: To compare the effect of groin approach and Stoppa approach in the treatment of ace-tabular fractures with 3D printing guide plate, and to find the best surgical approach. Method: In this study, 142 patients who were admitted to our hospital from January 2012 to January 2019 were selected. All patients were treated with preoperative 3D printing technology to simulate the injury types of acetabular fractures. The plates were pre molded or customized according to the type of fracture before operation. According to the surgical approach, they were randomly divided into two groups, including 68 cases of inguinal approach group, 46 cases of male and 22 cases of female. There were 74 cases in Stoppa approach group, including 51 males and 23 females. The data of CT + 3D reconstruction and CTA of iliac vessels were collected and saved in the form of DICOM and imported into mimic software for software processing to restore acetabular fractures. At the same time, using the software of 3ds Max 2013, the fracture reduction, screw position and size were designed. The exposure time, incision length and intraoperative blood loss were counted and recorded; the quality of acetabular fracture reduction was evaluated by Matta imaging score, and the hip joint function was evaluated according to the hip Postel score. Results: There was no significant difference in general data between the two groups (P > 0.05). The length of incision in Stoppa approach group was smaller than that in groin approach group, with shorter exposure time, less blood loss, shorter anesthesia time and recovery time (P < 0.05). There was no significant difference in the quality of acetabular fracture reduction evaluated by Matta imaging score between the two groups (P > 0.05). The Postel score of hip joint in the two groups had no statistical significance (P > 0.05). In the comparison of postoperative complications between the two groups, the Stoppa approach group was significantly lower than the inguinal approach group, with statistical significance (P < 0.05). Conclusion: The plate under 3D printing guide plate can achieve anatomical reduction and rigid internal fixation. Stoppa approach can reduce soft tissue damage and reduce intraoperative blood loss. It is more suitable for plate fixation of acetabular fracture under 3D printing guide plate.