3D printing auxiliary minimally invasive plate osteosynthesis (MIPO) reduces tibial malrotation incidence: A prospective randomized controlled study / 第二军医大学学报

ABSTRACT

Objective To compare the severity and incidence of tibial malrotation after treatment with minimally invasive plate osteosynthesis (MIPO), intramedullary nail technique (INT) and 3D printing auxiliary MIPO (3D-MIPO) for tibial fracture patients. Methods A total of 180 unilateral tibial fracture patients aged 16 to 60 years were enrolled from Shuguang Hospital of Shanghai University of Traditional Chinese Medicine between Jan. 2015 and Aug. 2017. Without consideration of the fracture classification, the patients were divided into MIPO group, INT group and 3D-MIPO group according to the order of the patients entering the study, with 60 cases in each group. The average ages of the patients in the MIPO, INT and 3D-MIPO groups were (39.18±9.10), (39.28±9.23) and (39.07±10.40) years old, respectively. Post-operative CT scanning was carried out at bilateral knee and ankle joint levels, and the differences of rotation angles between the affected side and the healthy side were measured and calculated. The absolute value of the difference that was greater than 10° was defined as malrotation. The severity and incidence of tibial malrotation were compared among the three groups. Results The MIPO, INT and 3D-MIPO groups had no significant differences in the gender, age, or fracture type. All the cases recovered smoothly without infection or loosening of internal fixation, and the wound exudation in individual patients was healed after dressing change. Mean difference value of rotation angle of the MIPO group was (6.85±3.82)°; 9 cases had internal rotation and 51 had external rotation; and 7 (11.67%) cases were diagnosed as tibial malrotation. The mean difference value of the INT group was (6.34±3.44)°, 10 internal and 50 external rotation, 6 (10.00%) tibial malrotation. And the mean difference value of the 3D-MIPO group was (3.96±2.24)°, including 8 internal and 52 external rotation, and 1 (1.67%) tibial malrotation. The mean difference value of rotation angle of the three groups was significantly different (F＝13.80, P0.01). The incidence of tibial malrotation in the 3D-MIPO group was significantly lower than those in the MIPO group and INT group (both P0.05). Conclusion 3D printing technology can help to reduce the incidence of tibial malrotation after treatment with MIPO.