中国组织工程研究 ›› 2016, Vol. 20 ›› Issue (13): 1904-1910.doi: 10.3969/j.issn.2095-4344.2016.13.011

• 数字化骨科 digital orthopedics • 上一篇    下一篇

胫骨平台骨折植入物内固定修复中3D打印技术的辅助应用

杨 龙1,王建吉1,孙 琦1,李 靖2,张俊标3,马敏先3,李江伟4,叶 川4   

  1. 1贵州医科大学,贵州省贵阳市 550004;2贵州省再生医学重点实验室,贵州省贵阳市 550004;贵州医科大学附属医院,3口腔科,4骨科,贵州省贵阳市 550004
  • 出版日期:2016-03-25 发布日期:2016-03-25
  • 通讯作者: 叶川,博士,硕士生导师,主任医师,教授,贵州医科大学附属医院骨科,贵州省贵阳市 550004
  • 作者简介:杨龙,男,1988年生,贵州省贵阳市人,汉族,2016年贵州医科大学毕业,硕士,医师,主要从事数字化骨科研究。
  • 基金资助:

     

    国家自然科学基金资助项目(81360232);贵阳市科技局资助项目(GY20141001)

Auxiliary application of three-dimensional printing technology of implant fixation for tibial plateau fracture

Yang Long1, Wang Jian-ji1, Sun Qi1, Li Jing2, Zhang Jun-biao3, Ma Min-xian3, Li Jiang-wei4, Ye Chuan4   

  1. 1Guizhou Medical University, Guiyang 550004, Guizhou Province, China; 2Guizhou Provincial Key Laboratory of Regenerative Medicine, Guiyang 550004, Guizhou Province, China; 3Department of Stomatology, 4Department of Orthopedics, Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou Province, China
  • Online:2016-03-25 Published:2016-03-25
  • Contact: Ye Chuan, M.D., Master’s supervisor, Chief physician, Professor, Department of Orthopedics, Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou Province, China
  • About author:Yang Long, Master, Physician, Guizhou Medical University, Guiyang 550004, Guizhou Province, China
  • Supported by:

    the National Natural Science Foundation of China, No. 81360232; the Project of Guiyang Science and Technology Bureau, No. GY20141001

摘要:

文章快速阅读:

文题释义:

3D打印技术:是快速成型技术的一种,是以数字模型文件为基础,运用粉末状金属或塑料等可黏合材料,通过逐层打印的方式来构造物体的技术。3D打印技术在临床上为患者定制个性化假体植入物、手术导航模板、个性化支具等方面均有报道,为外科手术在个性化和精准化方面提供了选择。
解剖型接骨板:由于患者个体在骨骼形态上及骨折的差异性,即使接骨板制造商将其规格型号分得足够细,其接骨板与骨骼表面的吻合性与螺钉的位置等并不理想,术前必须准备足够的、可能用到的接骨板型号和规格,即便如此仍出现解剖型接骨板“不解剖”,术中经常需要临时性再塑形,除非牺牲复位的正确性而迁就接骨板的形状。不仅增加了手术的操作难度,接骨板与骨表面的吻合性、内固定的稳定性和复位的正确性都难以保证。

 

背景:在胫骨平台骨折修复过程中,由于骨折形式多样化、解剖变化复杂、X射线片或三维CT平扫受到二维平面的局限,使得医生在术前计划和修复治疗时难度增大。3D打印技术在骨科的应用已引起重视。
目的:探讨3D打印技术在胫骨平台骨折术前计划和修复过程中的辅助作用。
方法:纳入30例胫骨平台粉碎性骨折患者,采用随机数字表法分为两组,试验组及对照组各15例。试验组经三维CT扫描,以DICOM格式储存,经Mimics软件处理,转换数据为可打印STL格式,通过熔融沉积型3D打印机,制作出1∶1实体大小的骨折模型,参照3D骨折模型制定修复方案。对照组患者常规参照影像学资料制定修复方案。比较两组患者的手术时间和术中出血量,并于治疗后12个月采用Rasmussen胫骨髁部骨折膝关节功能评分评定疗效。
结果与结论:试验组患者通过对1∶1等比例的3D打印模型进行分析研究,明确骨折类型后均顺利完成术前制定的修复方案。试验组手术时间及术中出血量均少于对照组,差异有显著性意义(P < 0.05)。所有患者治疗后获得12-18个月随访,骨折愈合时间为3-5个月,平均4.3个月。治疗后12个月采用Rasmussen胫骨髁部骨折膝关节功能评分评定疗效,试验组治疗优良率显著高于对照组(P < 0.05)。提示3D打印骨折模型有助于精确制定内固定修复方案,使得胫骨平台骨折的修复治疗更加精确、个性和直观。 ORCID: 0000-0001-5670-6289(叶川)

关键词: 骨科植入物, 数字化骨科, 胫骨平台骨折, 3D打印, 数字化建模, 计算机辅助设计, 个性化手术, 术前计划, 三维重建, 国家自然科学基金

Abstract:

BACKGROUND: In the treatment of tibial plateau fractures, because of the variety of fracture, the complexity of anatomical changes, X-ray films or three-dimensional CT scan limited by two-dimensional plane, increases the difficulty in preoperative plan and surgical treatment. The application of three-dimensional (3D) printing technology has attracted attention in the department of orthopedics.
OBJECTIVE: To explore the auxiliary role of 3D printing technique in preoperative plan and treatment for tibial plateau fractures.
METHODS: Thirty patients with tibial plateau comminuted fractures were enrolled in this study and divided into two groups: experimental and control groups, with 15 patients in each group. In the experimental group, patients underwent 3D CT scan, which was stored in DICOM format, and processed by Mimics software. Data were converted into STL format, entered 3D printer, and a 1:1 entity size of the fracture model was made, in accordance with repair plan of 3D fracture model. Operation time and intraoperative blood loss were compared between the two groups. At 12 months after treatment, their outcomes were assessed using Rasmussen evaluation criteria.
RESULTS AND CONCLUSION: The 3D printing fracture models of 1:1 ratio identified fracture type and made a repair program before surgery in the experimental group. Operation time and intraoperative blood loss were significantly less in the experimental group than in the control group (P < 0.05). After surgery, patients were followed up for 12 to 18 months. The healing time was 3-5 months, averagely 4.3 months. At 12 months after treatment, the Rasmussen evaluation criteria results showed that the excellent and good rate was significantly higher in the experimental group than in the control group (P < 0.05). These results suggest that the fracture model of 3D can help to make the operation plan. The treatment of tibial plateau fractures is more precise, personalized and visual.