Treatment outcomes of three-dimensional printing technology for foot and ankle fractures by junior versus senior physicians

doi:10.3969/j.issn.2095-4344.0306

Abstract

Abstract:

BACKGROUND: Three-dimensional (3D) printing technology has been extensively applied in foot and ankle surgeries, and it has achieved satisfactory treatment outcomes. However, whether its effect on the physicians with different seniority levels is different remains unknown.

OBJECTIVE: To analyze the difference of 3D printing technology effects on physicians engaged in foot and ankle surgeries with different seniority levels.

METHODS: Patients with a fracture of the foot and ankle admitted in the Affiliated Hospital of Binzhou Medical University from January 2015 to February 2017 were randomly assigned to different groups according to treatment using traditional technique or 3D printing technology by junior physicians and senior physicians, respectively: junior traditional group, junior 3D group, senior traditional group, and senior 3D group. The operation time, intraoperative blood loss, intraoperative fluoroscopy times, postoperative complications, postoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores were recorded and compared.

RESULTS AND CONCLUSION: (1) Eighty-nine eligible patients were included in the study, 29 patients were lost to follow-up for various reasons, and the remaining 60 patients completed the follow-up. All patients fracture healed at 3 months postoperatively. (2) The junior 3D group was significantly superior to the junior traditional group in the operation time, intraoperative bleed loss and intraoperative fluoroscopy time in the treatment of calcaneal fractures and three ankle fractures (P < 0.05). (3) There was no significant difference between senior traditional and senior 3D groups in the operation time, intraoperative bleed loss and intraoperative fluoroscopy time in the treatment of calcaneal fractures, metatarsal fracture and three ankle fractures. (4) Three cases of incision infection were found, including one case of superficial tissue infection in the junior 3D and senior traditional groups, and one case of deep infection in the junior traditional group. (5) There were no significant differences in the AOFAS scores between senior and junior groups (P > 0.05). (6) These results indicate that 3D printing technology plays a significant effect on the junior physicians in the operation time, intraoperative blood loss, and intraoperative fluoroscopy times. While, in terms of complications and functional recovery, the differences are slight between physicians.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Calcaneus, Ankle Joint, Fractures, Bone, Tissue Engineering

CLC Number:

R318

Zhu Ya-hui, Fu Bing-jin, Yin Gang, Wang Chao, Sun Guang-chao, Deng Ming-ming, Du Rui, Yang Jia-lin, Zhu Xiao-dong. Treatment outcomes of three-dimensional printing technology for foot and ankle fractures by junior versus senior physicians [J]. Chinese Journal of Tissue Engineering Research, 2018, 22(19): 3061-3066.

Figures/Tables 2

2.1 受试者数量分析滨州医学院附属医院2015年1月至2017年2月收治的253例足踝部骨折患者中包含闭合性跟骨骨折、三踝骨折、跖骨骨折患者共计203例，114例不符合标准给予排除，其中36例患有严重的心脑血管、呼吸系统、血液系统等疾病，78例患者拒绝签署知情同意书。符合标准的89例纳入此研究，其中29例在骨折愈合后(3个月余)拒绝到医院随访及电话随访，余60例得到完整随访数据。试验流程图见图1。 2.2 基本资料比较各组间基线资料比较差异均无显著性意义，见表1。 2.3 围术期指标及并发症比较分析 2.3.1 围术期指标比较分析 ①低年资3D组中所有患者围术期指标优于低年资传统组，其中跟骨骨折及三踝骨折患者差异有显著性意义(P < 0.05)，对于跖骨骨折患者差异无显著性意义(P > 0.05)；②高年资3D组跟骨骨折、跖骨骨折、三踝骨折患者围术期指标优于高年资传统组，但差异无显著性意义(P > 0.05)；③高年资传统组跟骨骨折、跖骨骨折、三踝骨折患者围术期指标优于低年资传统组，且差异有显著性意义(P < 0.05)；④低年资3D组与高年资3D组跟骨骨折、跖骨骨折、三踝骨折患者差异无显著性意义(P > 0.05)。结果表明低年资医师应用3D打印技术在治疗跟骨骨折及三踝骨折方面能明显缩短学习曲线，减少术中出血量、手术时间及透视次数；同时3D打印技术对高年资医师影响较小，见表2-4。 2.3.2 并发症比较分析该研究中共有3例患者发生切口感染，低年资3D组和高年资传统组各1例为浅表组织感染，经严格消毒换药后愈合；低年资传统组1例为深部感染，此患者为老年女性糖尿病患者，经严格控制血糖及清除坏死组织、多次换药等处理逐渐愈合。低年资传统组与高年资3D组各1例发生创伤性关节炎。所有患者骨折均在术后3个月左右愈合，无内固定装置移位的发生，除1例跟骨骨折患者及1例跖骨骨折患者因内固定置入处疼痛于术后7个月余去除内固定外，余患者内固定物均于术后12个月去除，见表5。"

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