3D打印辅助下跗骨窦切口治疗Sanders II、III型跟骨骨折

Treatment of Sanders II and III Calcaneal Fractures with 3D Printing Assisted Incision of Tarsal Sinus

摘要: 目的：观察3D打印辅助下采用跗骨窦切口微创治疗Sanders II、III型跟骨骨折的临床疗效；方法：前瞻性选取2017年1月至2022年12月在新疆医科大学第六附属医院就诊的Sanders II、III型跟骨骨折30例，所有患者均为闭合性骨折，术前采用薄层CT扫描，采用数字化软件Mimics 21.0进行三维重建骨折模型，3D打印机打印出骨折模型，根据骨折形态及类型选用和预制个体化锁定钢板进行虚拟固定。所有患者采用跗骨窦切口行手术治疗，术后定期随访跟骨宽度、跟骨高度、跟骨Böhler角、跟骨Gissane角及足踝协会踝–后足评分(AOFAS)。结果：30例均获得随访，随访时间平均15.2 (1224)个月。随访期间所有患者未出现骨折不愈合，内固定松动、骨折畸形愈合等并发症，1例患者切口愈合不良，换药后愈合良好。1例患者出现腓肠神经症状，术后1年取出内固定后恢复正常。末次随访时踝与后足功能AOFAS评分：优25例，良3例，可2例，优良率93.3%。结论：通过3D打印技术辅助下经跗骨窦微创切口手术入路治疗Sanders II、III型跟骨骨折具有切口小，手术时间短，临床疗效满意。

Abstract: Objective: To observe the clinical effect of minimally invasive treatment of Sanders II and III calca-neal fractures with the assistance of 3D printing and tarsal sinus incision. Method: Thirty cases of Sanders II and III calcaneal fractures admitted to the Sixth Affiliated Hospital of Xinjiang Medical University from January 2017 to December 2022 were prospectively selected. All patients had closed fractures. Thin-slice CT scan was performed before surgery, 3D fracture model was recon-structed by digital software Mimics21.0, and fracture model was printed by 3D printer. According to the shape and type of fracture, prefabricated and personalized locking plates were selected for vir-tual fixation. All patients were treated with tarsal sinus incision. Calcaneal width, calcaneal height, calcaneal Bohler Angle, calcaneal Gissane Angle, and foot ankle-posterior foot score (AOFAS) were followed up regularly after surgery. Results: All 30 cases were followed up for an average of 15.2 (12~24) months. During the follow-up period, there were no complications such as fracture nonun-ion, loose internal fixation, and malunion of fractures, etc. 1 patient had poor incision healing, and the healing was good after dressing change. One patient developed sural nerve symptoms, which returned to normal 1 year after removal of internal fixation. At the last follow-up, the AOFAS scores of ankle and hind foot function were excellent in 25 cases, good in 3 cases, and fair in 2 cases, with an excellent and good rate of 93.3%. Conclusion: With the assistance of 3D printing technology, the minimally invasive surgical approach through tarsal sinus for the treatment of Sanders II and III calcaneal fractures has small incision, short operation time and satisfactory clinical efficacy.