3D打印数字化导航模块辅助股骨颈中空拉力螺钉的精准置入  

Three-dimensional printing digital navigation modules-assisted accurate placement of femoral neck hollow lag screws

作　　者：陈旭[1] 余正希 陈宣煌[1] 张国栋[1] 吴献伟[1] 蔡涵华[1] 吴长福[1] 戴玉林[1] 

机构地区：[1]福建医科大学莆田学院附属医院教学医院南方医科大学附属莆田医院莆田学院附属医院骨科,福建省莆田市351100

出　　处：《中国组织工程研究》2016年第53期7979-7984,共6页Chinese Journal of Tissue Engineering Research

基　　金：福建省莆田学院科研基金项目(2015044);福建省自然科学基金资助项目(2015J01507)~~

摘　　要：背景:计算机辅助骨科技术可以帮助医生制定更加精确的术前计划和手术模拟,而3D打印技术则为虚拟设计和实施中架设了一座桥梁,将设计的手术方案精确地付诸于实施。目的:研究Mimics软件数字化设计结合3D打印导航模块辅助股骨颈中空拉力螺钉精准置入的关键技术,并在尸体标本上验证,观察效果。方法:采用成人尸体骨盆标本10个,制作20侧股骨颈骨折模型,经连续薄层CT扫描,采集Dicom格式图像。Mimics软件三维重建、确定中空拉力螺钉置入钉道、三维测量,根据骨面解剖结构设计带钉道的导航模块并3D打印,导向螺钉置入,完成内固定手术。观察卡位、置钉情况,以CT扫描评价置钉效果。结果与结论:共制作20个导航模块,植入60枚螺钉,观察股骨头及股骨颈周围骨质,未见螺钉穿透。术后行CT扫描重建,发现螺钉与术前设计相比,进钉点,进钉方向、长度均与Mimics软件中模拟的预定理想进钉点、方向和长度一致,准确率100%。导航模块和相对应的股骨大转子骨性结构贴合紧密,嵌合度良好,在应用时卡位及稳定性良好。说明在数字化设计及3D打印导航模块的辅助下,股骨颈中空拉力螺钉能精准置入到理想位置。BACKGROUND： Computer-assisted orthopedic technique can help physicians develop more accurate preoperative planning and surgical simulation. 3D printing technology erects a bridge for the virtual design and implementation, and the design of the surgical program will be accurately put into practice. OBJECTIVE： To investigate Mimics software digital design combined with 3D printing navigation modules-assisted accurate placement of femoral neck hollow lag screw, verify on corpse specimen, and observe its effects.METHODS： Ten adult cadaveric pelvic specimens were used to make 20 models of femoral neck fracture. After continuous thin-slice CT scan, Dicom format images were collected for three-dimensional（3D） reconstruction by using Mimics software to identify the path of hollow lag screw and for 3D measurement. According to anatomic structure of bone surface, navigation modules with screw path were designed for 3D printing. The screw was implanted and the fixation was finished. The position and screw placement were observed. CT scanning was used to evaluate its effects. RESULTS AND CONCLUSION： Totally 20 navigation modules were designed and 60 screws were implanted to observe the bone around femoral head and femoral neck. No screw penetration occurred. After surgery, reconstruction with CT scanning found that compared with preoperatively, the site, direction and length of screw insertion were consistent with that established by Mimics software. The accuracy rate was 100%. The navigation modules were closely bonded to the corresponding bony structure of greater trochanter of femur. Chimerism was good. The position and stability were good in the application. These results suggested that with the help of digital design and 3D printing navigation module, femoral neck hollow lag screw can be accurately placed into the ideal position.

关 键 词：股骨颈骨折 外科手术 计算机辅助 组织工程 骨科植入物 数字化骨科 导航模块 3D打印 螺钉 福建省自然科学基金 

分 类 号：R318[医药卫生—生物医学工程]