目的 探讨3D打印技术结合自制反向牵引架治疗高能量陈旧性Lisfranc损伤的临床疗效观察.方法 回顾分析中国人民解放军第八十集团军医院2014年12月至2019年12月收治的高能量陈旧性Lisfranc损伤患者22例,所有患者入院时间均超过1个月,男12例、女10例,年龄21～49岁.术前均行CT三维重建,根据重建情况给予3D打印,明确骨折移位情况,骨折Myerson分型:B型8例、C型14例.22例患者行切开复位内固定,采用克氏针、微型钢板固定,2例关节损伤严重行关节融合术.术后按照美国足踝外科协会(American Orthopaedics Foot and Ankle Society,AOFAS)评分标准对足部功能进行疗效评定.结果 所有患者均获得长期随访,随访时间为11～24个月,平均(15.3±1.7)个月;患者完全愈合时间为9～14周,平均(11.7±2.1)周.结论 3D打印技术结合自制反向牵引架治疗高能量陈旧性Lisfranc损伤的临床效果显著,有利于明确骨折移位情况.术前制订合理的治疗计划,每个跖骨通过持续反向牵引,有利于骨折复位、软组织恢复、坚强内固定,有利于足部功能的恢复.
2019年7月,收治1例自残致左腕部4平面离断伤。经多学科沟通,制定相应诊疗策略,给予输液、输血、纠正休克、降低血糖等对症治疗,同时左腕部多断面离断清创再植，术后应用心里干预,应对突发情况,术后患肢恢复好。
Objective To investigate the clinical effect of Schatzker typeⅤ,Ⅵtibial plateau fractures minimally in-vasively treated with traction frame and double-plate. Methods Forty patients with Schatzker type Ⅴ,Ⅵ fractures were divided into two groups:the minimally invasive treatment group of double plates combined with traction rod(ob-servation group) and the traditional open reduction and internal fixation with iliac bone graft(control group),with 20 cases in each group. The operative time, intraoperative blood loss, hospitalization time, time required to complete weight bearing, Rasmussen knee function scores of postoperative 6 months, and postoperative complications were compared between the two groups. Results All patients were followed up for 12~36 months. The observation group of operation time,intraoperative blood loss,hospitalization time,full weight-bearing time required were significantly less than the control group,the differences were statistically significant (P<0.05), hospitalization time difference between two groups was not statistically significant(P>0.05). At 6 months of postoperation,excellent and good re-sults of knee joint of observation group was higher than that in the control group,the complication incidence rate was significantly lower than the control group, the differences were statistically significant (P<0.05). Conclusions The clinical effect of the traction frame combined with the top bar and double plates minimally invasive treatment of tibial plateau fractures is better than the traditional open reduce to take iliac bone graft internal fixation. Knee joint can get good function recovery,reduce the incidence of postoperative complications.
