Application Of 3D Printing Technology In The Repair Of Complex Elbow Joint Fracture

ObjectiveTo explore the clinical effect and value of 3D printing technology in the surgical repair of complex elbow fractures.MethodFrom June 2017 to August 2019,38 patients who suffered from distal humeral articular surface comminuted fractures,distal humeral articular surface comminuted fractures with proximal ulna fractures,or proximal ulna articular surface comminuted fractures and underwent surgical repair in our hospital were divided into 3D printing group and control group in the order of admission,with 19 cases each.The all patients of the two groups were subjected to CT scanning and 3D reconstruction,after the 3D printing group exported and processed the CT image data,a 1: 1 3D fracture model was produced using a 3D printer,and the model was further subjected to CT scanning for 3D reconstruction.The 3D model and the 3D CT images were compared with the 3D CT fracture images to evaluate the accuracy of the model.Simulated surgical operation of fracture reduction and internal fixation in the solid model,and record the type,specification,place and direction of the internal fixation material in the simulated operation to make a formal surgical plan.The control group used X-ray,CT and other traditional image data,and the surgeon made preoperative planning based on clinical experience,formulated surgical plans.The patients of the two groups were treated by the same surgical team.Record the actual operation time,intraoperative blood loss,intraoperative X-ray fluoroscopy in all cases,and calculate the compliance of the internal fixation materials used in the formal operation of the 3D printing group.All patients were followed up for at least 6 months,and the clinical healing time of fractures and the occurrence of complications were compared between the two groups.The Mayo elbow function score was assessed to evaluate the elbow function in the 3D printed group and the control group before operation and 6 months after operation,compared the excellent rate of elbow joint function recovery.ResultBoth the 3D CT images of the model and the 3D model were compared with the 3D CT images of the fracture respectively.All showed no reduction in the number of bone pieces,no deformation of bone pieces,clear edges and edges without obvious passivation,and no significant change in the position of fracture pieces,suggesting that the 3D printed model has good accuracy and reflects the real information of fractures.The operation time,intraoperative blood loss and intraoperative fluoroscopy frequency of patients in the 3D printing group were significantly lower than those in the control group(P<0.05).The internal fixation placement in the 3D printing group was basically the same as that in the simulated surgery,and the average conformity degree of internal fixation was(96.79±4.88)%.All patients were followed up for 6-18 months(average 10.63±3.22 months),including the 3D printing group(10.68±2.77 months)and the control group(10.58±3.69 months).The 3D experimental group's preoperative Mayo score and the control group's Mayo score with no significant difference(P>0.05).The Mayo score of the 3D printing group(91.58±8.83 points)6 months after surgery was significantly higher than that of the control group(80.53±11.29 points),with a statistically significant difference(P<0.05).The excellent and good rate 94.7% of the 3D experimental group was higher than that of the control group 63.2%,and the difference was statistically significant(P<0.05).The fracture healing time of the two groups was recorded according to the standard of clinical fracture healing,and no significant difference was found in the results(P>0.05).There was no significant difference in the incidence of complications of incision infection,skin necrosis,delayed fracture healing and ulnar nerve injury between the two groups(P>0.05).There were no complications such as fracture deformity healing,internal fixation failure,and myositis ossificans occurred.Conclusion(1)The 3D printed model of the elbow joint has no obvious deformation of the bone shape and no obvious passivation of the edges,which can accurately reflect the true information of the fracture.(2)Compared with traditional surgery,3D printing technology applied to complex elbow joint fractures,can be in preoperative to develop personalized,accurate and reliable operation plan,significantly reduce the difficulty of intraoperative fracture reduction and fixation,shorten the operation time,reduce intraoperative blood loss,reduce the number of intraoperative X-ray fluoroscopy,significantly improve the surgical curative effect,worth clinical application.