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  

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

作　　者：杨龙[1] 王建吉[1] 孙琦[1] 李靖 张俊标 马敏先[3] 李江伟[4] 叶川[4] 

机构地区：[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 [3]贵州医科大学附属医院口腔科,贵州省贵阳市550004 [4]贵州医科大学附属医院骨科,贵州省贵阳市550004

出　　处：《中国组织工程研究》2016年第13期1904-1910,共7页Chinese Journal of Tissue Engineering Research

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

摘　　要：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。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.

关 键 词：胫骨 骨折 内固定器 组织工程 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 

分 类 号：R318[医药卫生—生物医学工程]