Perkutane Reposition und Stabilisierung einer dislozierten Acetabulumfraktur

In the treatment of acetabular fractures, anatomic reconstruction of the joint is the primary aim. To achieve this, rather large approaches with approach-related morbidity are needed. Percutaneous stabilizations are still limited to nondisplaced or minimally displaced fractures. For displaced acetabular fractures there are percutaneous procedures described with intraoperative CT control, requiring that CT be available in the OR and posing a logistic challenge. The fluoroscope Siremobil Iso-C3D offers the possibility of displaying osseous structures with CT-like quality using a fluoroscopy technique. The case of a minimally displaced acetabular T-type fracture with a clear articular step in the weight-bearing area is presented. The percutaneous reduction and stabilization after intraoperative control of the reduction quality with the Siremobil Iso-C3D is demonstrated. Using the enhanced fluoroscopy technology with the ability to generate axial cuts and reconstructions comparable to CT clearly improves the reduction control also in acetabular surgery. Thus even displaced acetabular fractures can be reduced and stabilized percutaneously. Anatomic reconstruction of the joint remains the primary aim.     

First clinical results and consequences of intraoperative three-dimensional imaging at tibial plateau fractures

Anatomic reduction and appropriate implant placement is essential for optimal treatment of intraarticular tibial plateau fractures. Standard intraoperative fluoroscopy provides limited visualization of the reduction and hardware placement compared with pre- or postoperative three-dimensional (3-D) imaging modalities. As such, postoperative computed tomography has become a common procedure to evaluate the quality of the reduction and fixation. The Iso-C3D provides 3-D intraoperative imaging to dynamically assess the surgical reduction and fixation at different anatomic regions. We report on our first 19 clinical tibial plateau fractures scanned intraoperatively with the Iso-C3D. When compared with conventional c-arm images, the Iso-C3D scans demonstrated improved ability to identify articular malreduction and implant malposition.     

Three-dimensional fluoroscopy for evaluation of articular reduction and screw placement in calcaneal fractures

BACKGROUND: Anatomic reconstruction of the posterior calcaneal facet after intra-articular fracture is one of the critical factors in achieving a good functional result. Intraoperative evaluation of fracture reduction and implant placement relies on direct view by standard fluoroscopy. We hypothesized that three-dimensional (3D) fluoroscopy is more accurate than conventional fluoroscopy, and equivalent to CT for determining fracture reduction and screw position in calcaneal fractures. METHODS: A Sanders type IIB fracture pattern was created in eight embalmed lower extremity cadaver specimens. First, the posterior facet was reduced with a step-off of 0 mm to 2 mm in 0.5-mm increments. All specimens had two dimensional (2D) fluoroscopy, 3D fluoroscopy with an Iso-C3D, and a CT scan. Next, screws were placed so they protruded into the subtalar and calcaneocuboid joint and through the medial wall. All specimens were imaged again. Three observers evaluated all imaging studies, and the sensitivities and specificities of each modality were determined. RESULTS: Both the Iso-C3D and the CT were more specific for anatomic reduction (75% and 100%, respectively) than fluoroscopy (62%). For the malreduced trials, the Iso-C3D and CT were both 100% sensitive, and the sensitivity of fluoroscopy was 63% (p < 0.001 for both). For the intra-articular screws, the Iso-C3D and CT were accurate in all cases (sensitivities = 100%), and fluoroscopy was accurate in five of the eight trials for both joints (sensitivities = 63%). Finally, with screws protruding through the medial wall, the sensitivity of fluoroscopy was 25%, for the Iso-C3D 88% (p = 0.02), and for CT was 100% (p = 0.003). CONCLUSIONS: Three-dimensional fluoroscopic imaging is more accurate than 2D fluoroscopy for detection of intra-articular incongruities and implant position and is similar to CT. CLINICAL RELEVANCE: This new technology may be particularly useful in assessing calcaneal fractures and may lead to improved fracture reduction, less implant misplacement, and improved patient outcomes.     

Die klinische Wertigkeit des ISO-C3D bei der Osteosynthese des Fersenbeins

We compared in a prospective study including 82 patients treated with ORIF of an intraarticular calcaneus fracture the quality of fluoroscopy, intraoperatively Iso-C(3D) and postoperative CT-scans. Therefore the posterior facet of the calcaneus (PFOC) was divided into three sectors. Joint steps and fracture gaps were detected by two independent investigators and statistically analysed. Another focus was to evaluate if the findings due to intraoperatively Iso-C(3D) assessment performed by the surgeon were correct and subsequently influenced the surgical procedure. There were no statistically differences between the Iso-C(3D)- and CT findings concerning joint steps or fracture gaps in PFOC sectors I-III. With fluoroscopy an assessment of the PFOC sectors I and II was not possible. In six cases (7.3%), intraoperative reduction was redone after performing an Iso-C(3D) scan. In ten cases, 12 malpositioned screws were replaced (12.2%/14.6%). These results suggest that intraoperative 3D Iso-C(3D) imaging provides a high diagnostic reliability. By careful assessment of the images the surgeons receive information which could lead to a change of the operative strategy.     

Value of 3D fluoroscopic imaging of acetabular fractures comparison to 2D fluoroscopy and CT imaging

Purpose Intraoperative two-dimensional (2D) fluoroscopy of acetabular fractures is difficult due to the complex three-dimensional (3D) anatomy. Intraoperative 3D fluoroscopy may have particular utility in the evaluation of acetabular fractures. We compared the accuracy of 3D fluoroscopic imaging in evaluating acetabular fracture displacement and implant placement with fluoroscopy and computed tomography (CT) scans. Methods In 24 cadaveric acetabuli, a transverse acetabular fracture was created. First a 2 mm step-off of the articular surface was created and reconstruction plates placed on the anterior and posterior columns. In 12 specimens, two screws were placed intraarticularly, protruded by 2 mm. In the remaining 12 specimens, the same constructs were used but the screws remained extraarticular. Second tests were designed to simulate an impaction injury. After hardware removal, a hollow trephine (diameter of 14.9 mm) was used to core a bonecyliner on the dome of the acetabulum, and impacted until it was recessed into the articular surface by 2 mm. Plates were placed, and screws were placed intraarticularly in 12 specimens, as in the first set of tests. All cadavers were imaged with standard 2D-, 3D fluoroscopy and CT. Three observers randomly evaluated all imaging studies for all specimens. Results For detection of intraarticular screws, both the Iso-C3D and the CT scans were significantly more sensitive (96 and 96%, respectively) and specific (96 and 100%, respectively) in detecting the intraarticular position compared to 2D fluoroscopy (75%; P < 0.05). Sensitivity of articular step-off detection was no different between the Iso-C3D (83%), CT (79%), and 2D fluoroscopy (87%). Articular impaction was correctly identified in 79% of specimens with the Iso-C 3 D technique, while the CT was accurate in 92%. 2D fluoroscopy was accurate in 62% for the impactions (P < 0.05 vs. CT). Conclusions 3D-fluoroscopic imaging appears to be extremely accurate in evaluating acetabular fracture constructs. Its sensitivity and specificity for evaluating intraoperative hardware was greater than with 2D fluoroscopy and equivalent to CT scan. Volumetric impactions were also reliably demonstrated on both of the 3D modalities, which were both superior to 2D fluoroscopy. Overall, Iso-C3D multiplanar imaging yields information regarding implant placement and articular reduction that is more detailed and accurate than standard fluoroscopy and is comparable to CT. This study has been approved by the local review board for ethical questions.     

The use of intraoperative three-dimensional imaging (ISO-C-3D) in fixation of intraarticular fractures

INTRODUCTION: The purpose of this study was to analyse the applicability and advantages of the intraoperative use of a mobile isocentric C-arm with three-dimensional imaging (Siremobil ISO-C-3D) in fixation of intraarticular fractures. METHODS: After the fixation was judged to be satisfactory relying on the images provided by routine fluoroscopy, intraoperative CT visualisation with ISO-C-3D was performed to evaluate the fracture reduction and implant position. Intraoperative revision was performed based on the additional information ISO-C-3D provided beyond routine fluoroscopy. ISO-C-3D was used on a series of 72 closed-intraarticular fractures in 70 patients. Fracture distribution was: calcaneus (25), tibial plateau (17), tibial plafond (12), acetabulum (11), distal radius (3), ankle Weber-C (3) and femoral head (l). The primary outcome measure was revision rate after final ISO-C-3D data acquisition and prior to wound closure. Secondary objectives were to measure the additional time required for ISO-C-3D use and to determine the rate of further re-do surgeries. RESULTS: Eight out of 72 (11%) fracture fixations were judged by the surgeon to require intraoperative revision following ISO-C-3D imaging. Prior to leaving the operating room, the surgeon was satisfied with fracture alignment in all the procedures. The mean additional operative time using ISO-C-3D was 7.5 min (8.2% of the mean total operative time). No patient required re-do surgery. CONCLUSION: : Intraoperative three-dimensional visualisation of intraarticular fractures enables the surgeon to identify inadvertent malreductions or implant malpositions which may be overlooked by routine C-arm fluoroscopy and hence may eliminate the need for re-do procedures. ISO-C-3D adds little operative time and may preclude the need for pre-operative and post-operative CT-scans in selected cases.     

Usefulness of intraoperative three-dimensional imaging in fracture surgery: a prospective study

BackgroundSince its introduction, intraoperative threedimensional (3D) imaging has enabled the analysis of articular fractures and implant positions during fracture surgery. The purpose of this study was to evaluate the usefulness of intraoperative 3D imaging in locating anatomic structures, correcting errors, and preventing revision surgery.MethodsBetween March 2010 and November 2012, intraoperative 3D imaging was used during surgery for 109 fractures in 101 patients. Fluoroscopy was performed with the Iso-C3D^™ (Siemens, Erlangen, Germany). We recorded the number of intraoperative revisions for adjustment of fracture reduction and correction of implant position for these fractures.ResultsCases comprised intra-articular fractures (55 %), disruptions of the posterior pelvic ring (33 %), and syndesmotic injury (12 %). The intraoperative revision rate was 9.2 % (10/109). When considered by fracture site, the revision rate was highest for syndesmotic injury (23.1 %), followed by iliosacral fixation (8.3 %) and intra-articular fractures (6.6 %). We changed the implant position in six cases, corrected the articular reduction in one case, and revised the malreduction of syndesmosis in three cases. No postoperative infection occurred in any of these cases. ConclusionsIntraoperative 3D imaging is useful for correcting errors and may prevent a second operation. Three-dimensional imaging may be especially helpful in intra-articular fractures, iliosacral screw fixation, and syndesmotic injury.     

3-D imaging with a mobile surgical image enhancement equipment (ISO-C-3D). Initial examples of fracture diagnosis of peripheral joints in comparison with spiral CT and conventional radiography

To analyze a prototype mobile C-arm image amplifier (Iso-C3D) in the evaluation of different joint fractures of the upper and lower limbs using multiplanar reconstruction (MPR). Different cadaver joint specimens (n = 14) were examined with a prototype (Iso-C3D, Siemens AG, Erlangen, Germany), plain radiographs (CR), and spiral computed tomography (CT). The motorized C-arm provides fluoroscopic images during a 190 degrees orbital rotation computing a 119-mm data cube. These three-dimensional data sets yielded MPR images, which were evaluated by two readers for the detection and extent of fracture lines. Initial data show that fractures were easily depicted and correctly classified on MPR images with the Iso-C3D and that there was no difference between the Iso-C and CT in the detection of fractures. The preliminary results suggest a remarkably good detection of joint fractures with the Iso-C3D. Studies in an adequate number of patients are required to elucidate whether these promising results can also be obtained in a clinical setting.     

Neue Möglichkeiten in der operativen Therapie von Fersenbeinfrakturen

Operative management of intra-articular calcaneal fractures is becoming increasingly widely established. Such treatment can only be successful if exact anatomical repositioning of the fracture fragments with reconstruction of the length and the angle of the joint of the tuber calcanei and, especially, of the subtalar joint is achieved. The mobile Siremobil^® Iso-C3D is the first device to permit intraoperative 3D visualization of the fracture, and it has become an important aid to exact anatomical repositioning of the fracture fragments. Any dislocation that persists after realignment can be detected and corrected at a very early stage. The realignment achieved can be maintained in the long term with the use of a fixed-angle implant. From October 2002 to May 2004, a total of 49 patients had fractures of the calcaneus treated surgically by internal fixation with fixed-angle plates. 3D Imaging was used during all these operations. On average, the angle of the tuber was improved by 16°. In 18 cases the intraoperative 3D imaging revealed dislocations by more than 1 mm, which we were able to correct. Secondary dislocation of the central fragment did not occur in any of these cases.     

Comparative study of the quality of C-arm based 3D imaging of the talus

Malposition of extraosseous or intra-articular screws, e.g., in osteosyntheses of joint fractures or in the vicinity of joints, frequently remains undiscovered in intraoperative fluoroscopy and is only recognized on postoperative computed tomography (CT) scans. The aim of the study, therefore, was to assess the value of a new mobile C-arm three-dimensional imaging device in comparison with fluoroscopy, conventional radiographs, and CT scans using an extremity model. Screws were inserted ventrally in four anatomic lower leg specimens without talus fractures parallel to the longitudinal axis to simulate surgical management of fractures of the talus. The specimens supplied were examined with fluorscopy, conventional radiography, spiral CT, and the new three-dimensional imaging with the SIREMOBIL Iso-C3D. These four modalities were evaluated by ten radiologists and ten trauma surgeons and were compared regarding subjective image quality and position of the screws. The quality of information acquired with the SIREMOBIL Iso-C3D was equal to that of the CT examinations, although image quality was considered inferior to fluoroscopy, conventional radiography, and CT (p < 0.001). In contrast to the previous procedure with intraoperative fluoroscopy and subsequent postoperative X-ray control, the results obtained with the SIREMOBIL IsoC3D were superior. The SIREMOBIL Iso-C3D is useful for the intraoperative diagnosis of small joints with few artifacts producing osteosynthesis material, i.e., for recognizing the position of screws in the region of glenoid surfaces.     

Operative Versorgung intraartikulärer Fersenbeinfrakturen

Correct reconstruction of the outer shape of the calcaneus, as well as anatomically true reconstruction of the articular surfaces are the main objectives of osteosynthesis and also a prerequisite for avoiding complications. Successful reconstruction of the articular surfaces was hitherto hindered by gaps in conventional intraoperative imaging as a result of the inability to directly visualize portions of the affected joint due to the anatomic layout. Image transformation systems are now available, which make intraoperative 3D imaging possible. In this way, axial reconstruction, implant position and the results of repositioning can be assessed during surgery for calcaneus fractures. In addition to the appropriate equipment, this method requires intensive training and a standardized procedure. 3D fluoroscopy is suited to improving process quality in the treatment of calcaneus fractures. Implant malpositioning can be avoided and the repositioning result of the articular surfaces can be monitored intraoperatively and improved where necessary. Corrective interventions can thus be avoided. An improved clinical outcome can be expected in the long term.     

Die intraoperative 3D-C-Bogen-Anwendung

Mobile C-arms with the option of 3D imaging like the Iso-C(3D) allow for intraoperative 3D visualization of anatomical areas with complex three-dimensional structures like articular surfaces. In an 8-year period we performed 1,841 intraoperative control scans following osteosynthesis. Among these patients we registered the number of intraoperative adjustments of fracture reduction and implant position in correlation to the area of surgery. The majority of intraoperative examinations in 1,841 patients was performed in fractures of the calcaneus (20.5%) and the upper ankle joint (13.2%). Altogether we improved the reduction or the implant position intraoperatively in 21.5%. The majority of intraoperative revisions was seen in osteosynthesis of the calcaneus (40.3%), the upper ankle joint (30.9%) and fractures of the distal tibia (29%). The rate of revisions over the time was very stable. Intraoperative need for revision of reduction or implant position is not a rare phenomenon in our experience. Intraoperative 3D imaging is a valid tool to recognize and adjust suboptimal reduction or implant positioning. Intraoperative 3D imaging can improve the quality of osteosynthesis especially in fractures of joints and complex anatomical areas.     

Does intraoperative fluoroscopic 3D imaging provide extra information for fracture surgery?

Fracture surgery of the extremities using 2D fluoroscopy frequently fails to detect the suboptimal positioning of implants and joint incongruities. The use of intraoperative 3D-rotational X-ray (3D-RX) imaging with a new X-ray device potentially reveals these failures. We compared 50 intraoperative (2D) results of surgery and certainty about the effectiveness of different aspects of fracture reduction as interpreted from conventional (2D) methods versus intraoperative 3D-RX in 42 distal extremity fractures by means of a surgery questionnaire. In addition, we investigated the need for revision surgery based on postoperative radiological findings in 81 patients. After fracture reduction, just before a 3D-RX scan, the surgeon preoperatively assessed the result of surgery. Three months after surgery, the 3D-RX scan was judged by three experienced surgeons independently. Intraoperative 3D-RX showed significantly more information as to screw positioning and rotation of the fracture reduction than the conventional method (p < 0.005). None of the 81 patients in whom 3D-RX was performed needed surgical revision based on postoperative radiological examinations. Intraoperative 3D-RX with this new device scanning offers additional information about extremity fracture reduction as compared to conventional intraoperative 2D imaging, and may reduce the need for revision surgery. The value of 3D-RX on functional outcomes still needs to be assessed. The Medical Ethics commission of the Academic Medical Center, University of Amsterdam has approved “Evaluation of the clinical merit and image quality of intraoperative 3D-RX imaging for fracture surgery of the wrist, elbow and ankle.”     

Perkutane navigierte Ballonreposition einer dislozierten Acetabulumfraktur

Kyphoplasty is a well proven surgical procedure for osteoporotic fractures in spine surgery. Anatomic reconstruction of the joint is the primary aim in the treatment of acetabular fractures. To achieve this, extensive approaches with entry related morbidity are usually needed. Percutaneous stabilisations are still limited for non- or minimally displaced fractures.For displaced acetabular fractures, there are percutaneous procedures described with intraoperative CT control or by the use of a 3D C-arm. The case of an anterior column posterior hemitranverse fracture with an articular step in the weight bearing area is presented. In this case, a kyphoplasty balloon was placed by use of 3D C-arm navigation. After 2D C-arm controlled fracture reduction, the supra-acetabular screw was inserted percutaneously using the previous 3D navigation data set.With the combination of kyphoplasty technique, intraoperative 3D C-arm control and 3D C-arm based navigation, this displaced acetabular fracture could be reduced and fixed percutaneously. Anatomic reconstruction of the joint remains the primary aim.     

Clinical indications and perspectives for intraoperative cone-beam computed tomography in oral and maxillofacial surgery.

OBJECTIVES: Intraoperative cone-beam computerized tomography (CBCT) imaging has been introduced in oral and maxillofacial surgery. Using midfacial fractures as the pioneer model, this study describes the spectrum of further promising clinical indications for intraoperative CBCT and a clinical combination with intraoperative navigation. STUDY DESIGN: One hundred seventy-nine patients admitted for surgical treatment of the facial skeleton were included in the study. Intraoperatively, 3-dimensional images were generated with the mobile CBCT scanner Arcadis Orbic 3D, obtained from Siemens Medical Solutions, in a variety of indications. RESULTS: The acquisition of the data sets was uncomplicated, and image quality was sufficient to assess the postoperative result in all cases. In the example of a facial gunshot injury, a navigation system for intraoperative localization of the metal foreign bodies was used.     

Klinische Erfahrungen mit dem Siremobil Iso-C3D-Bildwandler in der Beckenchirurgie

In pelvic and acetabular surgery intraoperative control of reduction and implant position is sometimes hard to achieve with conventional C-arm technology. The Siemens C-arm Iso-C(3D) imaging system enables axial cuts and two- or three-dimensional reconstructions to be generated. Following the good experience in surgery of the spine and extremities, its clinical applicability in pelvic surgery was evaluated in 30 patients in a prospective clinical trial. In all 20 patients with acetabular fractures reduction quality and implant position could be well assessed. In one postoperative examination an intraarticular screw placement was evident, which intraoperatively was not as clear and was revised. In one procedure an intraarticular fragment was visualized, and was extracted in the same procedure. In one procedure the use of the Iso-C(3D) system enabled the approach to be limited.In all ten pelvic ring injuries the osseous structures in the posterior pelvic ring could be visualized with an adequate image quality. Reduction quality and implant position could be assessed in all open and closed procedures. On two occasions the SI screws were navigated based upon the Iso-C(3D) dataset. Overall the use of the Iso-C(3D) system was successful in all cases. Image quality, which is clearly inferior to that of CT, was sufficient for the assessment of reduction quality and implant position. One revision was indicated, and one avoided. However, in spite of its advantages in pelvic surgery, handling, sterile covering and data transfer need to be improved. For bilateral pelvic injuries the image size is too small.     

Computer-assisted LISS plate osteosynthesis of proximal tibia fractures: feasibility study and first clinical results.

Fluoroscopy is the most common tool for the intraoperative control of long-bone fracture reduction. Limitations of this technology include high radiation exposure for the patient and the surgical team, limited visual field, distorted images, and cumbersome verification of image updating. Fluoroscopy-based navigation systems partially address these limitations by allowing fluoroscopic images to be used for real-time surgical localization and instrument tracking. Existing fluoroscopy-based navigation systems are still limited as far as the virtual representation of true surgical reality is concerned. This article, for the first time, presents a reality-enhanced virtual fluoroscopy with radiation-free updates of in situ surgical fluoroscopic images to control metaphyseal fracture reduction. A virtual fluoroscopy is created using the projection properties of the fluoroscope; it allows the display of detailed three-dimensional (3D) geometric models of surgical tools and implants superimposed on the X-ray images. Starting from multiple registered fluoroscopy images, a virtual 3D cylinder model for each principal bone fragment is constructed. This spatial cylinder model not only supplies a 3D image of the fracture, but also allows effective fragment projection recovery from the fluoroscopic images and enables radiation-free updates of in situ surgical fluoroscopic images by non-linear interpolation and warping algorithms. Initial clinical experience was gained during four tibia fracture fixations that were treated by LISS (Less Invasive Stabilization System) osteosynthesis. In the cases operated on, after primary image acquisition, the image intensifier was replaced by the virtual reality system. In all cases, the procedure including fracture reduction and LISS osteosynthesis was performed entirely in virtual reality. A significant disadvantage was the unfamiliar operation of this prototype software and the need for an additional operator for the navigation system.     

三维CT成像对胫骨平台骨折术前评价结果的信度与效度分析

目的 通过比较使用三维CT与二维CT影像时对胫骨平台骨折分型和骨折特征术前评定结果 的信度与效度,探讨三维CT的诊断优势.方法 4名骨科高年资医生回顾性分析2004年9月至2006年11月间收治的21例胫骨平台骨折患者的病历,分别使用二维CT和三维CT影像对骨折分型和骨折特征做出判断,使用一致性检验来分析骨折分型判断结果 的评定者间信度和评定者自身信度,和对骨折特征判断结果 的标准效度(术中观察结果 作为金标准),并用McNemar检验比较三维CT和二维CT判断结果 与金标准的一致性差异.结果 使用三维CT时,对骨折分型判断结果 的评定者间信度和评定者自身信度均改善为极度一致,对骨折特征判断结果 与金标准的一致性显著性高于二维CT(P=0.027).结论 使用三维CT影像能提高对胫骨平台骨折分型和特征术前评价的可靠性和准确性,三维CT对胫骨平台骨折术前评价有很高的应用价值.     

8 Jahre Erfahrung mit intraoperativer 3D-Bildgebung

Mobile C-arms with three-dimensional (3D) imaging, such as the Iso-C3D^, allow for intraoperative 3D visualization of anatomic areas having complex 3D structures, such as articular surfaces. Over an 8-year period we performed 1,841 intraoperative control scans following osteosynthesis. For these patients we registered the number of intraoperative adjustments of fracture reduction and implant position in correlation to the area of surgery. Most intraoperative examinations in these patients were done for fractures of the calcaneus (20.5%) or the upper ankle joint (13.2%). We intraoperatively improved the reduction or implant position in 21.5% of the patients altogether. The majority of intraoperative revisions were done in cases of osteosynthesis of the calcaneus (40.3%), injuries of the upper ankle joint (30.9%), or fractures of the distal tibia (29%). The revision rate over time was very stable. The intraoperative need to revise a reduction or implant position is not rare in our experience, and intraoperative 3D imaging is a valid tool to recognize and adjust suboptimal reduction or implant positioning.     

3D打印技术在Schatzker Ⅴ、Ⅵ型胫骨平台骨折术前规划中的应用

目的探讨3D打印技术在Schatzker Ⅴ、Ⅵ型胫骨平台骨折术前规划中的应用效果。方法回顾性分析2014年3月至2018年7月我院骨科收治的74例胫骨平台骨折病人的病例资料,根据术前是否使用3D打印技术进行手术规划分为3D打印组和常规组。其中3D打印组31例(31膝),男20例,女11例,年龄为(45.71±9.98)岁,Schatzker Ⅴ型19膝,Schatzker Ⅵ型12膝。常规组43例(43膝),男26例,女17例,年龄为(45.86±9.94)岁,Schatzker Ⅴ型30膝,Schatzker Ⅵ型13膝。记录并比较两组手术时间、术中出血量、术中透视次数、术后住院时间、骨折愈合时间、末次随访时影像学Rasmussen评分、美国特种外科医院膝关节评分(hospital for special surgery knee score, HSS)、疼痛视觉模拟量表(visual analogue scale, VAS)评分及并发症情况。结果 3D打印组手术时间为(96.29±8.92)min,术中出血量为(221.94±47.50)ml,术中透视次数为6(5,6)次,术后住院时间为9(7,14)d;常规组手术时间为(112.53±12.19)min,术中出血量为(296.28±74.26)ml,术中透视次数为8(7,9)次,术后住院时间为12(9,15)d,以上项目两组间比较,差异均有统计学意义(P均<0.05)。所有病人随访记录完整,3D打印组随访时间为(15.94±2.26)个月,常规组为(15.63±1.94)个月。两组间骨折愈合时间、末次随访时影像学Rasmussen评分、HSS评分、VAS评分的差异均无统计学意义(P均>0.05)。结论 3D打印技术在Schatzker Ⅴ、Ⅵ型胫骨平台骨折术前规划中的应用能缩短手术时间,减少手术中出血量,减少术中透视次数并能缩短术后住院时间。