快速成型模型在制定胫骨平台复杂骨折手术方案中的指导作用  

Rapid prototyping used in the operation design for complex fractures of tibial plateau

作　　者：孟国林[1] 刘建[1] 胡蕴玉[1] 裴国献[1] 袁志[1] 颜永年[2] 熊卓[2] 孙龙[1] 高嘉锴[1] 杨鹏[1] 

机构地区：[1]第四军医大学西京骨科医院,西安710032 [2]清华大学机械系

出　　处：《中华创伤骨科杂志》2011年第12期1135-1138,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨快速成型技术制备的模型在胫骨平台复杂骨折手术方案制定中的指导作用。方法2006年11月至2010年11月收治16例胫骨平台复杂患者，男10例，女6例；年龄27-68岁，平均39岁。术前根据X线片和CT进行AO分型：41B2．2型4例，4183．2型3例，4183．3型2例，41C2．1型1例，41C3．1型2例，41C3．2型2例，41C3．3型2例。术前均进行三维螺旋CT扫描，所得数据经转化输入快速成型机，制备出了1：1等大的快速成型胫骨平台骨折模型，明确骨折类型并指导制定手术方案，术后随访了解骨折愈合与患膝功能情况。结果2例患者骨折分型由AO4182．2型修正为4183．1型，1例患者骨折分型由41C2．1型修正为41C3．1型。模型上进行了损伤机制的分析和手术方案的制定。所有患者术后获9。22个月（平均14个月）随访；骨折均获骨性愈合，愈合时间4-6个月（平均4．7个月）；术后膝关节功能参照改良HSS膝关节评分系统评定：优11例，良3例，可2例，优良率为87．5％。结论采用快速成型技术制备的l：1等大胫骨平台骨折模型使骨折伤情更直观，骨折分型更加准确；可根据骨折模型制定手术方案，并可对内固定钢板进行预先塑形，对复杂类型的骨科手术方案的制定有较强的指导作用。Objective To explore the role of rapid prototyping （RP） in the operation design for complicated fractures of tibial plateau. Methods Included in the present study were 16 patients with complex fracture of tibial plateau who had undergone preoperative 3-D CT scanning before surgery from November 2006 to November 2010. Their CT data were transformed and imported, into a RP machine to pro- duce RP models of tibial plateau fracture with a ratio of 1： 1. The RP models were used for classification of tibial plateau fractures by AO system and operation design. Results According to the RP models, the classification was modified from AO type 41B2.2 to AO type 41B3. 1 in 2 cases and from AO type 41C2. 1 to AO type 41C3. 1 in one case. The RP models were also used to discuss fracture mechanisms and determine operation designs so that the following operations became simpler and less invasive. The follow-up period lasted from 3 to 22 months （14 months on average） . All the 16 patients got bone union from 4 to 6 months. According to the Evanich criteria, the function of the knee joint was rated as excellent in 11 patients, good in 3 and fair in 2, with a satisfactory rate of 87.5%. Conclusions RP models of complex tibial plateau fracture can help surgeons have a direct and clear visualization of the fracture to be treated. The RP models can make exact classification of the complex tibial fracture, and facilitate operation design, selection of internal fixation and preoperative remodeling of the steel plate to be used.

关 键 词：胫骨 骨折 成像 三维 快速成型 

分 类 号：R687.3[医药卫生—骨科学]