Therapeutic effect of preoperative 3D printing design combined with minimally invasive percutaneous plate internal fixation for the treatment of middle and lower tibiofibular fractures
Department of Trauma and Orthopaedics, the People's Hospital of Yizheng, Affiliated Yizheng Hospital of Yangzhou University Medical College, Yizheng 211400, China
Abstract：Objective To explore the clinical application of preoperative 3D printing design combined with minimally invasive percutaneous plate internal fixation (MIPPO) in the treatment of middle and lower tibiofibular fractures.Methods Retrospective analysis of clinical data of 110 patients with fractures of the middle and lower tibia in the Department of Orthopaedics, Yizheng People's Hospital from January 2012 to June 2017. Preoperative 3D printing design combined with minimally invasive percutaneous plate internal fixation technology (3D printing group) was performed in 48 patients, including 28 males and 20 females,17 on the left and 31on the right,aged from 19 to 68 (42.5±5.7) years.According to AO/OTA classification,there were 11 patients of type A, 19 patients of type B, and 18 patients of type C.Open reduction and internal fixation (ORIF group) was used in 62 patients, including 34 males and 28 females; 25 on the left and 37 on the right. aged from 21 to 72 (44.7±7.5) years. According to AO/OTA classification, there were 16 patients of type A, 22 patients of type B, and 24 patients of type C. The operation data such as incision length, the amount of bleeding, the X-ray exposure times, the hospitalization time, the fracture healing time, excellent and good rate of ankle joint function and incidence of complications were recorded and analyzed.Results All patients were followed up for 12.0 to 18.0 (13.6±2.5) months. The length of the incision (the cumulative length of the tibia) in the 3D print group and the ORIF group were (7.57±1.63) cm and (12.7±2.73) cm.The amount of bleeding were(45.7±10.5) mL and (120.3±17.9) mL, respectively.The hospitalization time of the two groups were (10.3±3.17) d and (13.9±3.43) d, respectively. The X-ray exposure times were (3.07±2.13) times and (1.46±1.85) times, respectively. The fracture healing time were(4.2±2.65) months and (5.9±2.32) months, respectively. The functional scores of the ankle joint Johner-Wruhs in the 3D print group and the ORIF group were excellent in 27 patients, good in 17 patients, fair in 4 patients, and excellent in 25 patients, good in 24 patients, fair in 11 patients, and poor in 2 patients, the difference was statistically significant (Z=2.555, P＜0.05); the complication rates were 0 (0/48) and 4.8% (3/62), respectively, and the difference was not statistically significant (χ2=0.912, P＞0.05).Conclusions Preoperative 3D printing design combined with minimally invasive percutaneous plate internal fixation for the treatment of the middle and lower tibiofibular fractures can fully evaluated fracture before surgery.It has minimal traumatic features such as less trauma and less bleeding, and can promote fracture healing and improve ankle function.
Johner R, Wruhs O. Classification of tibial shaft fractures and correlation with results after rigid internal fixation[J]. Clin Orthop Relat Res, 1983(178): 7-25.
Wani IH, Ul Gani N, Yaseen M, et al. Operative management of distal tibial extra-articular fractures-intramedullary nail versus minimally invasive percutaneous plate osteosynthesis[J]. Ortop Traumatol Rehabil, 2017, 19(6): 537-541. DOI:10.5604/01.3001.0010.8045.
[9]
Bear J, Rollick N, Helfet D. Evolution in management of tibial pilon fractures[J]. Curr Rev Musculoskelet Med, 2018, 11(4): 537-545. DOI:10.1007/s12178-018-9519-7.
[10]
Bai J, Wang Y, Zhang P, et al. Efficacy and safety of 3D print-assisted surgery for the treatment of pilon fractures: a meta-analysis of randomized controlled trials[J]. J Orthop Surg Res, 2018, 13(1): 283. DOI:10.1186/s13018-018-0976-x.
Yavuz U, Sökücü S, Demir B, et al. Comparison of intramedullary nail and plate fixation in distal tibia diaphyseal fractures close to the mortise[J]. Ulus Travma Acil Cerrahi Derg, 2014, 20(3): 189-193. DOI:10.5505/tjtes.2014.92972.
[14]
Kwok CS, Crossman PT, Loizou CL. Plate versus nail for distal tibial fractures: a systematic review and meta-analysis[J]. J Orthop Trauma, 2014, 28(9): 542-548. DOI:10.1097/BOT.0000000000000068.
2019, Vol. 24 
