探讨联合3D打印技术、在腕关节镜辅助下经皮微创复位、内固定治疗累及关节面的桡骨远端骨折的临床疗效。

2019年1月至2021年1月根据术前准备方式、诊断明确的桡骨远端骨折等纳入标准选择顺德和平外科医院住院患者112例，排除病理性骨折、陈旧性骨折、恶性肿瘤及无法手术等病例。应用随机数字表将其分为两组，3D打印组57例和对照组55例。3D打印组根据患者术前CT检查结果进行3D打印骨折的模型，再根据模型制定手术方案、选择内固定材料，术中在腕关节镜辅助下经皮微创复位、内固定治疗骨折；对照组行常规术前准备，术中亦在腕关节镜辅助下经皮微创复位、内固定治疗。观察指标包括围手术期情况、视觉模拟评分(VAS)评估治疗后腕关节疼痛和Gartland-Werley功能评分评估功能、影像学测量指标等。采用独立样本t检验或者卡方检验。

与对照组比较，3D打印组的术中透视次数(t＝7.87)、手术时间减少(t＝9.02)、术中失血量减少(t＝10.92)、住院时间减少(t＝3.20)均有减少(均为P<0.05)。3、12个月随访时与对照组比较，3D打印组腕关节的疼痛评分下降、功能评分更优，随访3个月时与对照组的比较，3D打印组患者腕关节功能评分优良率更高(χ²＝5.30，P<0.05)。

在累及关节面的桡骨远端骨折的患者中应用3D打印模型，术中在腕关节镜辅助下经皮微创复位、内固定治疗骨折，定位精准、手术快、损伤少，减轻患者痛苦，有利于腕关节功能的恢复。

To investigate the clinical efficacy of combined 3D printing technology with the wrist arthroscope-assisted percutaneous minimally invasive procedure in reduction and internal fixation for distal radius fractures involving articular surface.

From January 2019 to January 2021, 112 patients received treatment for distal radius fractures in the Shunde Heping Surgery Hospital were selected according to the inclusion criteria such as confirmed diagnosis of fractures of the distal radius. Pathological fractures, old fractures, bone malignant tumours and the patients who were unsuitable for surgery were excluded. The patients were assigned into the 3D printing group (3D group, n=57) and the control group (n=55) by random number table. In the 3D group, the 3D fracture templates were printed according to the preoperative CT scans. Then surgical procedures were formulated and the internal fixation materials were selected according to the 3D templates. During surgery, fractures were treated by percutaneous minimally invasive reduction and internal fixation with the assistance of wrist arthroscope. In the control group, conventional preoperative preparations were applied, and the percutaneous minimally invasive reduction and internal fixation treatment under the assistance of wrist arthroscope were carried out in surgery. The observation included perioperative data, postoperative wrist pain and function. Visual analogue scale (VAS) and Gartland-Werley function scores, as well as imaging measurement were employed for the evaluation. Independent sample t test or Chi square test were used for data analysis.

Compared with the control group, the number of intraoperative X-ray exposure (t=7.87), operation time (t=9.02), intraoperative blood loss (t=10.92) and length of hospital stay (t=10.92) in the 3D group were all seen in decrease (all P<0.05). In comparison with the control group in follow-up reviews at three and 12 months, the scores of wrist pain were lower together with better function scores in the 3D group. Follow-up reviews at three months showed that the wrist function score in the 3D group was better than the control group (χ²=5.30, P<0.05).

For patients with fractures of the distal radius with injury of articular surface, a preoperative 3D printed temperate would benefit the plan of surgical procedures, perform intraoperative percutaneous minimally invasive reduction and internal fixation though wrist arthroscope, ensure more accurate positioning, reduce an operation time and minimise a damage and reduce the pain. It also benefits the recovery of wrist function.