To investigate the clinical efficacy of pre-operative simulation using a three-dimensional (3D) printing model for surgical treatment of old and complex tibial plateau fractures. Forty-two patients with old and complex tibial plateau fractures were retrospectively reviewed from January 2014 to January 2018, which were divided into a conventional planning group (n = 22) and a planning with 3D printing group (n = 20). In the planning with 3D printing group, preoperative equal-ratio fracture models prepared using the 3D printing technique were used to perform pre-operative simulation and guide the real surgical operation. In the conventional planning group, the operation was performed based on pre-operative computed tomography (CT) images. Surgery duration, blood loss and the number of fluoroscopy during operations were recorded. During follow-up, the quality of fracture reduction and complications were also recorded. Knee functions were evaluated using the hospital for special surgery (HSS) scoring system. The operation time, blood loss and the number of fluoroscopy during operation in the planning with 3D printing group were less than that in the conventional planning group (P < 0.01). All patients were followed up for mean of 24.38 ± 7.62 months. The rate of excellent fracture reduction in the planning with 3D printing group and conventional planning group was 75% and 45.45%, respectively (P = 0.05). The complication rate was 15% in the planning with 3D printing group and 31.82% in the conventional planning group. At the final follow-up evaluation, the mean HSS score was 86.05 ± 7.67 in the planning with 3D printing group and 79.09 ± 6.75 in the conventional planning group (P = 0.003). The rate of excellent results in the planning with 3D printing group was 70% and in the conventional planning group was 45.45% (P = 0.083). In conclusion, pre-operative simulation using a 3D printing model may be helpful for the treatment of old and complex tibial plateau fractures, which may be conducive to the pre-operative planning and to making the surgical procedure accurate and personalized. However, its clinical effectiveness need to be further assessed by a prospective randomized-controlled study.

为了研究使用三维（3D）打印模型进行手术模拟的老年和复杂胫骨平台骨折的术前模拟的临床疗效。2014年1月至2018年1月，对42例陈旧复杂的胫骨平台骨折患者进行了回顾性检查，分为常规计划组（n = 22）和3D打印计划（n = 20）。在3D打印计划小组中，使用3D打印技术准备的术前等比例骨折模型用于进行术前模拟并指导实际的外科手术。在常规计划组中，手术是基于术前计算机断层扫描（CT）图像进行的。记录手术时间，失血量和术中透视的次数。在跟进过程中，还记录了骨折复位的质量和并发症。使用医院的特殊手术（HSS）评分系统评估膝关节功能。使用3D打印的计划组的手术时间，失血量和手术中的透视检查次数少于常规计划组（P  <0.01）。所有患者平均随访24.38±7.62个月。在3D打印组和常规计划组中，骨折的优良复位率分别为75％和45.45％（P  = 0.05）。在3D打印组的计划中，并发症发生率为15％，在常规计划组中，并发症发生率为31.82％。在最终的随访评估中，在3D打印组的计划中，平均HSS得分为86.05±7.67，而在常规计划组中，则为79.09±6.75（P  = 0.003）。在3D打印组的计划中，优秀结果的比率为70％，在常规计划组中为45.45％（P = 0.083）。总之，使用3D打印模型进行术前模拟可能有助于治疗陈旧复杂的胫骨平台骨折，这可能有助于术前规划，并使手术过程准确，个性化。但是，其临床效果需要通过一项前瞻性随机对照研究进行进一步评估。