3D打印导板在Bernese髋臼周围截骨术中的应用  

Application of 3D reconstruction navigation template in Bernese periacetabular osteotomy

作　　者：周游[1] 徐小山[2] 李川[2] 康晓鹏[1] 陈昊[1] 王均[3] 朱崇涛[2] 李伟[3] 陆声[2] 

机构地区：[1]昆明市儿童医院,650034 [2]成都军区昆明总医院骨科,650032 [3]昆明医科大学第一附属医院骨科,650032

出　　处：《中华创伤骨科杂志》2016年第1期17-23,共7页Chinese Journal of Orthopaedic Trauma

基　　金：云南省科技计划重点项目（2014FA049）

摘　　要：目的探讨3D打印导板在辅助Bernese髋臼周围截骨术（PAO）的可行性。方法应用3D打印导板技术对2013年7月至2015年3月收治的26例（26髋）髋臼发育不良患者施行PAO，男10例，女16例；右髋14例，左髋12例；年龄为12—32岁，平均18．6岁。术前对患者行骨盆X线片检查及CT扫描，CT断层数据导入Mimics10．1软件中进行三维重建，模拟髋臼周围截骨及游离髋臼的旋转，制定术前规划；在逆向工程软件中根据术中可暴露的骨盆表面形态和旋转后的髋臼截骨面设计导板，将导板以STL格式导入3D打印机，打印出导板实物；术中将消毒后的导板贴敷于骨盆和截骨面，辅助完成精确髋臼周围截骨和游离髋臼的旋转移位；对术前、模拟术后及实际术后测量的外侧边缘中心（LCE）角、臼顶倾斜（AC）角、股骨头超出（EI）指数及覆盖率等参数进行比较。结果本组患者手术时间为2．7～4．6h，平均3．2h；术中出血量为950～3300mL，平均1630mL。所有患者术后检查均未出现股神经和坐骨神经损伤；未出现截骨进入髋关节内等严重并发症。无一例患者术后发生感染。1例患者出现后柱断裂。患者术前与实际术后测量的LCE角、AC角、EI指数及覆盖率比较差异均有统计学意义（P〈0．05）。模拟术后与实际术后测量的LCE角、AC角、EI指数及覆盖率比较差异均无统计学意义（P〉0．05）。结论基于CT三维重建设计和3D打印的导板应用于PAO，可以提高该手术的精确性及安全性，是解决该手术难点的有效方法。Objective To explore the feasibility of using a navigation template designed based on CT 3D reconstruction in Bernese periacetabular osteotomy （PAO）. Methods The 3D print navigation template technology was introduced in the Bernese pefiacetabular osteotomy for 26 patients （26 hips） with aeetabular dysplasia from July 2013 to March 2015. They were 10 males and 16 females, 12 to 32 years of age （average, 18.6 years） . There were 14 right hips and 12 left ones. Preoperative patients were prepared by pelvic plain film, CT scan, CT data reconstruction and simulated aeetabular osteotomy and rotation in Mimics10. 1 software. According to preoperative planning, reverse engineering technology was applied to extract the pelvic anatomic morphology and the osteotomy surface of operative field. Navigation templates were designed and manufactured by 3D printing technology. In operation, the navigation template was attached onto the exposed pelvis and osteotomy surface with complete accurate rotation displacement of osteotomy and acetabular bone block. Lateral center-edge （LCE） angle, acetabular index （AC）, extrusion index （EI） and femoral coverage were analyzed. Results The operation time for this group ranged from 2. 7 to 4.6 hours, averaging 3.2 hours. Intraoperative bleeding ranged from 950 mL to 3,300 mL, averaging 1,630 mL. No injury to the femoral nerve or sciatic nerve was observed in this group. No serious complications like bone fragments into the hip joint occurred. Postoperative infection was not found in all the cases. Posterior column breakage occurred in only one case. There were significant differences between the preoperative and postoperative measurements regarding LCE, AC, El and femoral coverage （ P 〈 0. 05）, but there were no significant differences between the above measurements after simulated operation and actual operation （ P 〉 0. 05） . Conclusion Since application of the navigation template designed based on CT 3D reconstruction in PAO can improve the surgical accura

关 键 词：髋发育不良 截骨术 计算机辅助设计 3D打印 导板 

分 类 号：R687.31[医药卫生—骨科学]