Clinical Study On The Application Of 3D Printing Technology In The Internal Fixation Of Comminuted Fracture Of Tibial Plateau

Background:Comminuted fractures of tibial plateau are mostly caused by high-energy injuries,often accompanied by surface collapse of tibial plateau,displacement of comminuted bone pieces and dislocation of knee joint.Different injury mechanisms lead to different types of fractures,and the structure of tibial plateau is complex,which makes it difficult to achieve satisfactory anatomical reduction of fractures during surgical treatment.Traditional surgery has the disadvantages of large incision,wide exposure range and serious blood supply damage at the fracture end,which may cause postoperative infection,joint deformity,screw loosening,thrombosis and traumatic arthritis(PTOA).In recent years,the development of digital orthopedics and 3D printing technology has brought new ideas for the treatment of comminuted fracture of tibial plateau.3D printing technology is known as "the symbol of the third industrial revolution".Following the forefront of digital orthopedics and 3D printing technology,this study intends to complete the clinical research on the application of digital design and 3D printing technology in the internal fixation of comminuted fracture of tibial plateau,which proves that its precise and individualized characteristics can provide accurate and comprehensive factual basis for clinicians,and the treatment scheme of fracture surgery under the guidance of 3D printing model is safer,more convenient and more comprehensive,accumulating valuable experience for the clinical diagnosis and treatment of comminuted fracture of tibial plateau guided by 3D printing technology.Obejective:Patients with comminuted fracture of tibial plateau were divided into observation group(operated according to 3D printing model design)and control group(operated by conventional method).By comparing the relevant data before and during operation and the recovery of knee joint function after operation,the significance of 3D printing model in treating comminuted fracture of tibial plateau was discussed.Methods:The observation group first prepared a 1:13D printed model according to the imaging data of patients,designed a surgical plan on the 3D printed model,and reset the fracture and the articular surface of the proximal tibia.After satisfactory reduction,it was fixed with towel tongs,and anatomical plates and screws were placed.Record the pre-bending degree of steel plate and the length and angle of screws,and bring them into the operating room after disinfection.Before operation,the 3D printed fracture model was disinfected and then brought to the operating room.If necessary,the displacement of fracture pieces was analyzed during operation and the placement method of implants was guided.The control group made preoperative planning and operation according to the imaging examination of the patients.After the fracture reduction and fixation were satisfactory during the operation,the fracture reduction and internal fixation were examined by C-arm X-ray fluoroscopy.After washing the incision,the negative pressure drainage tube was retained in the incision,and the incision was sutured without tension,and the appropriate pressure was applied to bandage and record the data.Ask the patients to review regularly,observe the internal fixation in place,and use the American Knee Society Knee Score(KSS)to evaluate and grade the recovery of knee joint function,and record relevant data.Results:All patients were followed up for 6 months.The operation time,intraoperative blood loss and intraoperative fluoroscopy times in the observation group were shorter(less)than those in the control group(P < 0.05).Six months after operation,the knee flexion degree in the observation group was bigger than that in the control group(P < 0.05).There was no significant difference between the two groups in the length of surgical incision,the time of initial weight bearing,the time of callus formation,the time of fracture healing and the X-ray of knee joint 6 months after operation(P > 0.05).There was no significant difference in KSS score and rating between the two groups at 1,3 and 6 months after operation(P > 0.05).Conclusion:The application of 3D printing technology in the surgical treatment of patients with comminuted fracture of tibial plateau plays a positive role in shortening the operation time,reducing the surgical trauma,and promoting the recovery of knee joint function after operation.