Application of 3D printing technology in preoperative
planning of scapular fracture

doi:10.3969/j.issn.2095-4344.1987

Abstract

Abstract:

BACKGROUND: The current internal fixation surgery for scapula fractures is limited by the complex anatomical structure of scapula, which is often difficult to operate, with much bleeding and time-consuming.

OBJECTIVE: To observe the clinical efficacy of the application of 3D printing technology in scapula fracture surgery.

METHODS: The clinical data of 28 cases (aged 34-70 years) with scapula fractures in the Second Affiliated Hospital of Nanjing Medical University from January 2016 to December 2018 were analyzed retrospectively. Among them, 14 cases were treated after routine preparation (control group). Another 14 patients underwent 64-slice thin-slice CT scanning and 3D reconstruction. The fracture model was printed with 3D printing technology. The surgical approach was designed and the internal fixation was customized before the operation (3D printing group). The operation time, intraoperative blood loss and intraoperative X-ray frequency of the two groups were recorded. Imaging data were followed up six weeks after the operation. The treatment effects were evaluated according to the Hardegger shoulder joint function assessment standard. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee.

RESULTS AND CONCLUSION: (1) All the 28 operations were successfully completed. The operation time, intraoperative blood loss and X-ray frequency of the 3D printing group were all less than those of the control group (P < 0.05). (2) The excellent and good rate of the 3D printing group was higher than that of the control group (P < 0.05). (3) The operative approach and internal fixation used in the 3D printing group were consistent with the preoperative design. The application of 3D printing technology in the surgical treatment of scapula fractures can help surgeons better understand the characteristics of scapula fractures and make surgical plans, reduce the difficulty of surgery, obtain more accurate reduction, reduce the duration of surgery, intraoperative bleeding and intraoperative X-ray fluoroscopy, and improve the surgical efficacy.

Key words: 3D printing, scapula fractures, fracture models, designed internal fixator, accurate reduction, preoperative planning, simulated surgery

CLC Number:

Zhang Han, He Bin, Wang Boyao, Qin Hu, Wang Yunhua, Fan Lei. Application of 3D printing technology in preoperative planning of scapular fracture[J]. Chinese Journal of Tissue Engineering Research, 2020, 24(12): 1864-1869.

Figures/Tables 5

2.6 不良反应情况两组均未发生感染、静脉血栓形成、内固定松动、内固定断裂、医源性神经损伤。 2.7 典型病例介绍患者男，34岁，主因“车祸外伤致右肩疼痛伴活动受限2 h”入院。入院诊断为：右侧肩胛骨骨折，右肘及右小腿皮肤擦伤，肺挫伤。入院后查X射线片示：右侧肩胛骨骨折；CT示：右侧肩胛骨粉碎性骨折，右侧第2肋骨折可能，右肺挫伤待排，两肺肺大泡。专科查体：右侧肩部肿胀明显，有压痛，纵向叩击痛(+)，活动明显受限。右肘关节擦伤，活动稍受限。右手指活动可，感觉稍差，肌力5级，肌张力正常，末梢血运可。右小腿胫骨前缘皮肤3处皮肤擦伤，余肢体未见明显异常。依据Hardegger分型为肩胛骨体部骨折。入院后即完善三大常规检查，予前臂吊带固定患肢，止痛消肿等对症处理。根据右肩胛骨CT扫描及三维重建的数据，应用3D打印机(华森医疗公司)打印出1∶1的骨折模型及复位后模型，选用该公司的个体化锁定解剖钢板，在复位后模型上设计锁定解剖钢板放置的位置，螺钉数量、长度，钉道方向，同时模拟手术过程。入院8 d后行切开复位内固定手术治疗。患者全麻后取左侧卧位，常规消毒铺巾。取右侧肩胛骨后方“L形”切口，长约30 cm，逐层沿着肩胛冈和肩胛骨内侧缘切开皮肤、皮下组织，沿着肩胛下窝向外侧推开冈下肌，向外侧掀开肌皮瓣，暴露骨折断端，可见骨折断端位移明显，粉碎性骨折，复位骨折断端，参考3D打印模型术中正确放置钢板位置，沿着内外侧缘放置2块定制锁定解剖钢板，克氏针临时固定后，钻孔测深，安放螺钉，C臂机透视下可见骨折复位良好，内固定物在位，活动肩关节活动良好。切口放置一根扁形引流管。清点敷料器械无误后，缝合关节囊，皮下组织及皮肤。无菌敷料及绷带加压包扎。手术顺利，术中麻醉满意，术中出血300 mL，输红细胞悬液2 U，血浆375 mL。术后安返病房，止痛消肿等对症支持治疗。手术时间150 min，术中透视次数4次。术中使用的钢板和螺钉的规格及方向与术前设计一致。术后按计划行功能锻炼，术后2 d、6周、9个月复查影像学检查均满意。术后8 d，出院回家休养，术后14 d返院拆线，手术切口情况良好，术后6周门诊复查肩关节活动情况，肩关节Hardegger评分为优。手术前后影像学资料，见图2。 "

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