3D打印个体化手术导航模板引导儿童股骨颈骨折空心螺钉置入的应用  

Surgical Technique of Cannulated Screw Placement Guided by 3D Printing Template in Pediatric Femoral Neck Fracture

作　　者：郑朋飞[1] 楼跃[1] 徐鹏[1] 唐凯[1] 

机构地区：[1]南京医科大学附属南京儿童医院南京医科大学数字医学研究所

出　　处：《中国数字医学》2016年第6期14-17,共4页China Digital Medicine

摘　　要：目的:探讨利用计算机辅助设计和3D打印技术制作的个体化手术导航模板实现儿童股骨颈骨折空心螺钉精确置入的可行性。方法:选取1例儿童股骨颈骨折患者,依据CT数据使用计算机辅助模拟骨折复位和股骨颈空心螺钉置入过程,通过软件设计并打印出与复位后股骨近端匹配的经颈螺钉置入导航模板,术前3D模型模拟手术验证可行后,术中在导航模板辅助下置入导针及螺钉。结果:3D打印的导航模板术中与股骨近端骨性标志匹配良好,能够辅助螺钉精确置入股骨颈并稳定骨折端,螺钉置入后经术中X检查与术前设计基本一致。螺钉置入的手术时间约为12min,术中使用X线透视仅4次。术后X线片示股骨颈骨折复位良好,两枚空心螺钉的进钉点、进钉方向、螺钉长度均与术前设计方案一致,螺钉未损伤骺板。术后3个月随访,股骨颈骨折临床愈合,按Ratliff评价标准评价髋关节术后功能情况为优,螺钉无松动、断裂。结论:3D打印个体化手术导航模板可以辅助股骨颈空心螺钉的精确置入,减少医源性股骨颈骨骺及血供损伤,节省手术时间,减少术中出血,减少患者及手术操作人员的射线暴露,值得推广应用。Objective: To investigate the feasibility and accuracy of a drill template for the placement of screws in femoral neck based on digital design and 3D printing technology. Methods: The preoperative CT images of 1child with femoral neck fracture were collected. With the data, the individual proximal femur model was made by the 3D printer. The reduction of fracture and the cannulated screw of femoral neck were simulated by the computer. The screw which was through the femoral neck designed by the software and printed to match the proximal femur after reduction was placed into the navigate template. After the feasibility of the 3D model operation was demonstrated before the operation, the guide pins and the screws were inserted with the help of the navigate template in the operation. Results: In the surgery, the navigate template with the individual design of 3D printing technology matched the bony markers of proximal femur. 2 screws were able to accurately insert the femoral neck and stabilize the end of the fracture. The result was basically the same between the X-ray after the operation and the design before the operation. The implantation of cannulated screw cost on 12 minutes, X-ray was used in the operation only 4 times the wounds were healed in one stage. Post-operation X-ray showed good of fracture of femoral neck. The entry point, the orientation and the length of the screws were all consistent with virtual schemes and no screw was worn out. A 3-month follow-up demonstrated the femoral neck fracture has healed and the function of hip joint was excellent according to Ratliff. No implant failures occurred during the entire follow-up period. Conclusion: By the means of 3D printing technology, accurate placement of individualized femoral neck cannulated screw can berealized. This technology can reduce iatrogenic femoral neck epiphyseal and the damage of blood supply, also can save the operation time, reduce intra-operative hemorrhage, and decrease patients and the personnel radiation exposure in the operation.

关 键 词：儿童股骨颈骨折 空心螺钉 手术导板 3D打印技术 

分 类 号：TP334.8[自动化与计算机技术—计算机系统结构] R683[自动化与计算机技术—计算机科学与技术]