目的 设计一种贴附于髂前上棘的新型3D打印导板，探讨使用该导板辅助骶髂螺钉置入治疗骨盆后环骨折的精确性与安全性。 方法 回顾性分析2021年3月至2024年3月我院采用骶髂螺钉技术治疗骨盆后环损伤的60例患者的临床资料，其中27例应用3D打印髂前上棘贴骨导板辅助置入骶髂螺钉（研究组）；33例采用常规透视下徒手经皮置入骶髂螺钉（对照组）。两组患者性别、年龄、受伤至手术时间、受伤方式以及骨折分型等基线资料差异比较均无统计学意义（P>0.05）。比较术中出血量、单枚骶髂螺钉的植钉时间、C臂透视次数、导针调整次数及术后并发症发生情况；术后复查CT，以Smith评级评估螺钉置入优良率，以Matta评分评估骨盆复位质量；同时测量术前和术后螺钉通道的偏移来评估置钉精确性；末次随访采用Majeed评分评价功能恢复情况。 结果 研究组术中出血量多于对照组（P<0.05），螺钉置入时间、透视次数和导针调整次数少于对照组（P<0.05）；两组术后螺钉置入Smith评级、Matta评分以及Majeed评分差异无统计学意义（P>0.05），但对照组出现1例穿出骶孔导致神经症状；研究组实际螺钉进钉点和终点处位置与术前设计位置之间的偏差分别为（3.91±1.88） mm、（4.37±2.53） mm，偏差角度为（4.10±2.05）°。结论 3D打印髂前上棘贴骨导板技术应用于骨盆后环骨折的骶髂螺钉固定能显著缩短螺钉置入时间、减少术中透视与导针调整次数，并有效降低螺钉穿出骨皮质的风险，从而提升了手术效率与置入安全性。
Abstract
Objective To design a novel 3D-printed guide plate attached to the anterior superior iliac spine (ASIS) and evaluate its efficacy and safety in assisting sacroiliac screw placement for the treatment of unstable posterior pelvic ring injuries. Methods A retrospective analysis was conducted on 60 patients with posterior pelvic ring injuries treated with sacroiliac screw fixation in our hospital from March 2021 to March 2024. Among them, 27 patients underwent sacroiliac screw placement assisted by the 3D-printed ASIS guide plate (study group), while 33 patients received conventional fluoroscopy-guided percutaneous manual screw placement (control group). There were no statistically significant differences in baseline characteristics such as gender, age, time from injury to surgery, injury mechanism, or fracture classification between the two groups (P>0.05). Comparisons were made regarding intraoperative blood loss, screw placement time per screw, number of fluoroscopic exposures, number of guidewire adjustments, and incidence of postoperative complications. Postoperative CT scans were reviewed to assess the excellent rate of screw placement using the Smith criteria and the quality of pelvic reduction using the Matta score. The accuracy of screw placement was evaluated by measuring the deviation of the actual screw trajectory from the planned trajectory preoperatively and postoperatively. Functional recovery at the final follow-up was assessed using the Majeed score. Results Intraoperative blood loss was greater in the study group than in the control group (P<0.05). The screw placement time, number of fluoroscopic exposures, and number of guidewire adjustments were all significantly lower in the study group (P<0.05). There was no statistically significant difference between the two groups regarding postoperative screw placement according to the Smith classification, pelvic reduction quality according to the Matta score, or functional recovery according to the Majeed score (P>0.05). However, one case in the control group experienced screw penetration into the sacral foramen, resulting in neurological symptoms. In the study group, the deviations between the actual entry and target points of the screws and their virtual planned positions were (3.91±1.88) mm and (4.37±2.53) mm, respectively, the deviation angle was (4.10±2.05)°. Conclusions The application of the 3D-printed ASIS guide plate technique for sacroiliac screw placement in posterior pelvic ring fractures can reduce screw placement time, decrease the number of intraoperative fluoroscopic exposures and guidewire adjustments, and lower the risk of screw penetration through the bone cortex, thus improving surgical efficiency and screw implantation safety.
关键词
3D打印技术 /
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骨盆骨折 /
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骶髂螺钉置入准确性
Key words
3D printing technology /
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Pelvis fracture /
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Sacroiliac screw accuracy
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基金
四川省医疗卫生与健康促进会2022年度省级科研（KY2022SJ0020）；遂宁市卫生健康科技计划项目（24ZDJB01）
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