Objective: To evaluate the effectiveness of unstable pelvic fractures treated by cannulated screw internal fixation with the assistance of three-dimensional (3D) printing insertion template.
Methods: The clinical data of 10 patients who underwent surgical treatment for unstable pelvic fractures by cannulated screw internal fixation with the assistance of 3D printing insertion template between May 2015 and June 2016 were retrospectively analysed. There were 7 males and 3 females with an average age of 37.5 years (range, 20-58 years). The causes of injury included falling from height in 5 cases, crushing from heavy load in 1 case, and traffic accidents in 4 cases. The interval from injury to admission was 1-5 hours (mean, 3.1 hours). The fracture situation included 6 cases of sacral fracture, 1 case of right sacroiliac joint dislocation, and 3 cases of iliac bone fracture. There were 10 cases of superior and inferior pubic rami fracture, including 3 cases on the left side (2 cases of suprapubic fracture adjacent to symphysis pubis), 2 cases on the right side, and 5 cases on the bilateral. All fractures were classified according to the Tile system, there were 4 cases of type B2, 1 of type B3, 4 of type C1, and 1 of type C2. The radiological outcome was evaluated by Matta scale, and the positions of the iliosacral screw and superior pubic ramus screw were evaluated according to 3D reconstruction of CT postoperatively. The functional outcome was evaluated by Majeed function scale.
Results: The average time of each screw implantation was 30 minutes, and the average blood loss per screw incision was 50 mL. The time of implantation of each sacroiliac screw was 24-96 seconds (mean, 62 seconds), and the time of implantation of each suprapubic screw was 42-80 seconds (mean, 63.2 seconds). The hospitalization duration was 17-90 days (mean, 43.7 days). All incisions healed by first intention. All patients were followed up 12-22 months (mean, 15.6 months). The radiological outcome was excellent in 8 cases and good in 2 cases according to Matta scale; and 3D reconstruction of CT demonstrated that all the 9 iliosacral screws were placed as type Ⅰ, and all the 13 suprapubic ramus screws were placed as grade 0 on the first postoperative day. No complication such as neurovascular injury, screw back out or rupture, or secondary fracture displacement was observed during the follow-up. At 6 months after operation, the X-ray films showed good fracture healing in all the 10 patients. The functional outcome was excellent in 9 cases and good in 1 case according to Majeed scale at 1 year after operation. One patient sustained Tile C2 pelvic disruption complicated with L 5 nerve root injury achieved complete nervous functional recovery at last follow-up.
Conclusion: It has advantages of precise screw insertion and lower risk of neurovascular injury to treat unstable pelvic fractures by cannulated screw internal fixation with the assistance of 3D printing insertion template, which can be a good alternative for the treatment of unstable pelvic fractures.
目的: 评估 3D 打印导板辅助空心螺钉内固定术治疗不稳定性骨盆骨折的疗效。.
方法: 回顾分析 2015 年 5 月—2016 年 6 月采用 3D 打印导板辅助空心螺钉内固定术治疗的 10 例不稳定性骨盆骨折患者临床资料。男 7 例，女 3 例；年龄 20～58 岁，平均 37.5 岁。致伤原因：高处坠落伤 5 例，重物压伤 1 例，交通事故伤 4 例。伤后至入院时间 1～5 h，平均 3.1 h。骶骨骨折 6 例，右侧骶髂关节脱位 1 例，髂骨骨折 3 例；10 例均有耻骨上下支骨折，左侧 3 例（其中 2 例耻骨上支骨折邻近耻骨联合），右侧 2 例，双侧 5 例。骨折 Tile 分型：B2 型 4 例，B3 型 1 例，C1 型 4 例，C2 型 1 例。术后根据 Matta 评分标准进行影像学评估，根据 CT 三维重建评估骶髂螺钉和耻骨上支螺钉位置，按照 Majeed 功能评分进行功能评估。.
结果: 患者平均每枚螺钉植入时间为 30 min，平均每枚螺钉切口失血量为 50 mL。每枚骶髂螺钉植入透视时间为 24～96 s，平均 62 s；每枚耻骨上支螺钉植入透视时间为 42～80 s，平均 63.2 s。住院时间 17～90 d，平均 43.7 d。术后患者切口均Ⅰ期愈合。患者均获随访，随访时间 12～22 个月，平均 15.6 个月。术后 1 d 根据 Matta 评分标准评定获优 8 例，良 2 例；CT 三维重建示 9 枚骶髂螺钉位置均为Ⅰ类，13 枚耻骨上支螺钉位置均为 0 级。随访期间均未出现血管神经损伤，螺钉退出、断裂，继发性骨折移位等并发症。术后 6 个月 X 线片示骨折均已愈合。术后 1 年根据 Majeed 功能评分评价功能，获优 9 例，良 1 例。末次随访时，合并左侧 L 5 神经根损伤的 Tile C2 型患者 L 5 神经根功能恢复正常。.
结论: 3D 打印导板辅助空心螺钉内固定术治疗不稳定性骨盆骨折有助于精确植入螺钉、降低血管神经损伤风险，是治疗不稳定性骨盆骨折的一种较好选择。.
Keywords: Unstable pelvic fracture; insertion template; internal fixation; three-dimensional printing technology.