3D打印技术在股骨髁上骨折医患沟通中的效果研究  

Study on effects of supracondylar fractures of three-dimensional printing technique on physician-patient communications

作　　者：林钢[1] 李鹏[1] 肖菊姣 李鉴轶[3] 彭文标 黄旭科[1] 孙向华[1] 

机构地区：[1]中山市古镇人民医院骨科,广东省创伤救治科研中心古镇基地,南方医科大学数字医学研究所3D打印中心古镇基地,广东中山528421 [2]中山市古镇人民医院泌尿外科,广东中山528421 [3]南方医科大学基础医学院人体解剖学教研室,广东省医学生物力学重点实验室,广州510515

出　　处：《中国临床解剖学杂志》2017年第3期336-340,345,共6页Chinese Journal of Clinical Anatomy

基　　金：广东省科技计划项目(2015A040404022,2014A020212200);广东省医学生物力学重点实验室开放基金(2016MB003);中山市科技计划项目(2015B1264)

摘　　要：目的探讨Mimics18.0软件数字化设计结合3D打印骨折模型进行手术规划,术前模拟手术,辅助治疗复杂型股骨髁上骨折内固定及在医患沟通环节的效果研究。方法筛选10例复杂型股骨髁上骨折患者,将患者的骨折部分及全套内固定物的薄层CT数据导入Mimics 18.0软件,进行骨折三维建模、骨折块虚拟复位、建立股骨髁上骨折内固定物标准件库、选取最佳匹配的钢板及螺钉。3D打印出患者1:1的股骨髁上骨折实体模型,术前应用3D打印模型与患者及其家属沟通并进行3D打印模型的效度验证。让患者及其家属直接接触骨折3D模型并观看在模型上按照数字化设计进行模拟手术—将股骨髁上重建板的位置、钉道长度和方向同数字化设计比较,确定术中使用的钢板及螺钉。最后,按照术前模拟演练进行实际手术骨折复位、钢板内固定。结果术前应用3D模型获得了良好的沟通效果,患者及其家属理解度和满意度高。应用3D打印技术模拟手术共植入1块锁定钢板和8枚螺钉,钢板植入的位置、螺钉植入的方向均与数字化术前设计高度一致,钉道长度与数字化术前设计比较无显著性差异(P>0.05)。实际手术与模拟手术的手术效果一致。结论数字化设计结合3D打印技术在医患沟通方面效果显著,且实现了复杂型股骨髁上骨折的个体化、精准化治疗,明显减少了患者的术中出血量,缩短了患者的康复周期。Objective To explore the surgical strategy of internal fixations for supracondylar fractures of femur using Mimics18.0 digital software combining with three-dimensional （3D） printing technique. Methods Thin slice CT scan data of 10 cases of complicated supracondylar fractures of femur and the data of all the internal fixations were imported into Mimics18.0 software to reconstruct 3D models, where virtualfracturesreductions were performed,standard parts library of internal fixations were established, and the most appropriate plates and screws were chosen. A 1：13D femur model was printed to simulate the surgery based on the digital design. Comparisons were made on the plate positions, screw passage lengths and screw directions to determine the final internal fixations. After that, the fracture reductions and internal fixations were performed in the reality surgery. An evaluation scale was handed out to patients and their relatives to investigate their altitudes to surgery simulations and 3D printing models. Results 3D printing is of great use in reductions of supracondylar fractures. In simulated surgery of the typical case, 1 reconstruction plates and 8 screws were implanted in the 3D printing model, and the plate positions and the screw directions were in high accordance with those measured in Mimics 18.0 software. The comparisons great value in individualized surgery and precise treatment, and can result in good physician-patient communication effects.

关 键 词：数字化设计 3D打印 股骨髁上骨折 医患沟通 

分 类 号：R323.5[医药卫生—人体解剖和组织胚胎学]