中文摘要：

目的探讨术前应用3D打印技术模拟手术及术中采用高位髂腹股沟入路治疗复杂髋臼骨折的临床疗效。方法回顾性分析2013年1月至2016年1月治疗的24例复杂髋臼骨折患者资料，男18例，女6例；年龄24-68岁，平均（39．2±13．8）岁；骨折类型按Letournel—Judet分型，其中横断骨折6例，“T”形骨折4例，前柱＋后半横断骨折4例，双杜骨折10例；受伤至手术时间4-18d，平均9d。患者术前均摄骨盆前后位X线片、CT＋三维重建及髂吡管CTA，将骨盆CT及CTA扫描数据导入Mimics软件进行三维重建，计算机模拟手术，虚拟内固定设计，并采片J3D打印快速成型技术打印个体化仿真骨盆模型，在模型上预演示骨折复位顺序，确定安放内固定物的种类及最佳位置，钢板塑彤备刚，记录螺钉长度及万向。手术均采用高位髂腹股沟入路。结果手术切口长度8-13cm，平均9cm；手术时间90-220min，平均130min；术中出血量300-1500ml，平均600ml。骨折复位后，内固定安放均一次完成，且贴服良好，与术前模拟内固定一致。24例患者均获得随访，随访时间15-30个月，平均18．3个月。骨折均完全愈合，愈合时间3-6个月，平均4．2个月。骨折复位按Matta标准评价，其中优16例，良6例，可2例，优良率91．7％（22／24）。Matta改良的Merle d＇Aubigne和Postel坪分为13-18分，平均16．5分，其中优13例，良6例，可5例，优良率79．2％（19／24）。术后第1天，2例患者出现股外侧皮神经损伤症状，1个月后好转；术后第3天，1例患者出现伤口脂肪液化，经定期换药，2周后伤口完全愈合；无一例发生腹股沟疝或腹壁疝及其他术后并发症。结论应用3D打印快速成型技术，可以在术前体外模拟骨折复位，确定内固定物安放最佳位置，坝弯铡板，测量螺钉长度及置入方向，可大幅减少手术时间和术中出血量，降低术后并发症?

英文摘要：

Objective To investigate the clinic, al outcomes in the treatment of complex acetahular fi＇actures through a single supra-ilioinguinal approach after the application of preoperative 3D printing and rapid prototyping simulating the opera- tive procedure. Methods From Januapy 2013 to January 2016, 24 eases of complex pelvic and acetabular fi＇actures in our hos- pital were retrospectively analyzed. Among them 18 cases were male and 6 were lemale. The average age was 39,2±13.8 years （range, 24-68 years）. According to Letournel-Judet＇ s classification, there were 6 eases of transverse, 4 eases of ＂T＂ shaped, 4 eases of combined anterior column and posterior hemi-transverse （ACPHT） and 10 cases of 2-column fractures. The time fi＇om injured to operation averaged 9 days （range, 4-18 days）. Before operation, pelvic AP view, three-dimensional CT as well as CTA of lilac blood vessels was taken routinely in all cases. The CT and CTA scan data were then imported into Mimics software for 3D reconstruction, Surgical simulation and optimal placement of internal fixations were performed on computer. After that, the individual simulated model of the pelvis was printed by the use of 3D printing and rapid prototyping technique. The order of reduction, selection and optimal position of the implants were determined. The plates were bent betore operation and the length and direction of the screws were recorded. A uniform supra-ilioinguinal approach was used in all eases. Results The length of incision averaged 9 cm （range, 8-13 cm）. The operative time average 130 min （range, 90-220 min）. The blood loss averaged 600 ml （range, 300-1 500 ml）. Once a satisfactory reduction was obtained, single placement of the plates was achieved. In accordance with the preoperative plan, the plates were perfectly fitted to the bone surface. The 24 patients were followed for an average time of 18.3 months （range, 15-30 months）. The fractures healed in all cases. The average healing time was 4.2 months （range, 3-6