3D Printing Combined With Lateral Condyle Osteotomy For The Treatment Of Schatzker Type IV Tibial Plateau Fractures Involving The Posterior Lateral Condyle

ObjectiveThis study compared and analyzed the clinical outcomes of the Schatzker type IV(fracture-dislocation)fracture of the tibial plateau with the use of traditional surgical methods and 3D printing combined with tibial lateral condyle osteotomy for the treatment of collapse of the posterolateral articular surface,including preoperative planning,operation time,Intraoperative blood loss,postoperative knee function,etc.,evaluate the clinical efficacy of external tibial osteotomy in the treatment of tibial plateau fractures involving posterolateral condylar.It is hoped that this study will summarize and characterize the characteristics of the Schatzker IV(fracture-dislocation)tibial plateau fractures with combined posterolateral articular surface collapse,improve the tibial osteotomy technique,define the surgical adaptation range of the technique,and standardize the osteotomy procedure.We hope to propose a systematic treatment plan for this type fracture that provides new ideas for clinical treatment of complex tibial plateau fractures.MethodWe included 42 patients with Schatzker type IV(fracture-dislocation)fractures of the tibial plateau who were admitted to the Second Hospital of Jianghan University,the Fourth Hospital of Wuhan City,from January 2016 to June 2017 as subject of randomization.Divided into observation group(group A)and control group(group B),that is,3D printing combined with tibial external osteotomy osteoarthritis auxiliary therapy group and traditional open reduction and internal fixation group.Both groups of patients were treated with anterolateral and posteromedial surgical approach for internal fixation and bone grafting.The surgery was performed by the same group of doctors.The patients in the study group underwent CT scans before surgery and the data were imported into Mimics 19.0.After processing,an equal-fractional fracture model was printed using the 3D printing technology.According to the model-designed surgical plan,the appropriate size and type of steel plate and the position of the steel plate were selected before surgery.According to the model,the steel plate is pre-curved to simulate the preoperative operation.In the control group,preoperative planning was performed through routine imaging data to complete the surgery.Observe the comparison of knee joint function activity before and after surgery and intraoperative and prognosis.Inclusion criteria: 1.The patient's age was 18 years old;2.After an X-ray examination,an imaging specialist with an advanced title and an orthopedic surgeon jointly diagnosed as the Schatzker IV tibial plateau fracture;3.The CT scan was diagnosed as a posterolateral tibial plateau fracture;4,no surgical contraindications;5,the patient agreed to surgery.Exclusion criteria: 1.The patient's age was <18 years old;2.By the X-ray and CT examination,the Schatzker IV tibial plateau fracture without combined with posterolateral condylar fractures;3.Surgical contraindications and inability to tolerate surgery;4.Pathological fracture patients;5,the patient refused.ResultAll the operations were completed successfully.The mean operation time of the study group was 112.3�14.8 min,which was significantly shorter than that of the control group 143.6�21.8 min.The mean intraoperative blood loss of the study group was 206.6�24.6 ml;it was significantly lower than the control group 260.3�35.4 ml.The average follow-up time was 14.3 months(12 to 17 months).Fractures were healed in 42 patients and the average healing time was 12 weeks(11 to 14 weeks).The average knee joint function Rasmussen score was 25.7 points(19 to 29 points)in the study group and 21.5 points(19 to 27 points)in the control group.There was statistical difference between the two groups.The difference of preoperative and postoperative Rasmussen scores was statistically significant(P<0.05).The study group was excellent in 15 cases,good in 6 cases,fair in 1 case,good rate was 95.45%,control group was excellent in 12,and good in 5 cases.There were 3 cases with excellent and good rate of 85%.The difference was statistically significant.All patients had functional recovery and no complications.The amount of blood loss,operation time,and fracture healing time in the study group were less than those in the control group,and the difference was statistically significant(P < 0.05).ConclusionTreatment of Schatzker IV tibial plateau fractures with 3D printing combined with humerus condyle osteotomy is more effective than traditional surgical methods.Compared with conventional surgical procedures,it can effectively shorten the operation time,reduce intraoperative blood loss,and improve knee function activity.degree.3D printing combined with digital design enables individualized and precise treatment of complex high-energy tibial plateau fractures.At the same time,the 3D printing equal-fractional fracture model is also conducive to communicating with patients,reducing medical risks,and has promotion value.