3D打印快速成型技术在髋臼骨折分型及年轻医生培养中的应用  

3D-printing rapid prototyping used in classification of acetabular fractures and education of young surgeons

作　　者：李明[1] 孙亮[1] 马腾[1] 任程[1] 刘德印[1] 路遥[1] 刘宏亮[1] 王谦[1] 段宁[1] 薛汉中[1] 卢代刚[1] 李忠[1] 朱东[2] 张堃[1] 

机构地区：[1]西安交通大学医学院附属红会医院创伤骨科,710054 [2]吉林大学白求恩第一医院创伤骨科,长春130021

出　　处：《中华创伤骨科杂志》2017年第2期140-145,共6页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然科学基金（11432016,11272134）;陕西省科技厅社发攻关项目（2015SF110,2015SF116,2013K14.02.12）;陕西省自然科学基金基础研究项目（2012JM4024）

摘　　要：目的探讨3D打印快速成型技术在髋臼骨折分型及年轻医生培养中的应用效果。方法回顾性分析2016年1月至6月期间收治的20例髋臼骨折患者资料。选择6名创伤骨科医生作为观察者，按从事创伤骨科工作的年资、职称和髋臼骨折的手术经验分为高年资组与低年资组，每组3人。对20例患者影像学资料（骨盆及髋臼系列X线片、骨盆CT平扫及三维重建图片）和3D打印骨盆实体模型（1：1）进行随机编号。所有观察者独立地依次对所有影像学资料和3D打印模型作出Letournel-Judet分型结论并记录（第1轮分型）。4周后重新进行随机编号，各观察者重复以上分型过程并记录（第2轮分型）。通过Kappa一致性检验计算观察者间信度和观察者自身信度。结果第1轮分型结果显示观察者间信度：高年资组医生以影像学资料和3D打印模型进行髋臼骨折分型判断的Kappa系数分别为0．887、0．962，而低年资组医生分别为0．659、0．849。将两组医生的第2轮分型结果与第1轮分型结果进行比较，得出观察者自身信度：高年资组医生基于影像学资料和3D模型的自身信度Kappa系数分别为0．906、0．925，而低年资组医生分别为0．696、0．849。结论应用3D打印实体模型较传统影像学资料能够有效提高医生对髋臼骨折分型的可靠性，其对年轻医生的影响更为显著，在年轻医生的培养过程中具有一定教学意义。Objective To explore the application of 3D-printing rapid prototyping in classification of aeetabular fractures and education of young surgeons. Methods The data of 20 patients with acetabular fracture were reviewed in this study who had been treated between January and June 2016. Three junior or- thopedic surgeons and 3 senior ones were chosen as observers. The conventional radiographs （X-ray films of the pelvis and acetabulum, CT scans and 3D reconstruction images of the pelvis） and 3D-printing rapid pro- totyping models of the 20 patients （ 1 ： 1 ） were randomly numbered. All the observers were asked to make Letournel-Judet classification of each radiograph and 3D-printing model independently in the first assessment. Four weeks later in the second assessment, all the observers were asked to make the same classifications after all the conventional radiographs and 3D-printing models were randomly numbered again. The kappa statistics was used to evaluate inter- and intra-observer agreements among the recorded results. Results At the first assessment, the inter-observer agreement was 0. 887 and 0. 962 respectively for conventional radiographs and3D-printing models in senior surgeons while 0. 659 and 0. 849 in junior surgeons. The second assessment showed the intra-observer agreement was 0. 906 for radiographs and 0. 925 for 3D-printing models in senior surgeons while 0. 696 and 0. 849 in the junior ones. Conclusions Compared with conventional radio- graphs, since 3D-printing models can effectively enhance the reliability of acetabular fracture classification, they may be more helpful for young surgeons in understanding acetabular fractures.

关 键 词：髋臼 骨折 分型 医学教育 3D打印技术 

分 类 号：R683[医药卫生—骨科学] TP391.73[医药卫生—外科学]