基于3D打印的骨折复原技术在胫腓骨远端骨折中的应用  

Fracture restoration technique based on 3D printing used in distal tibiofibular fractures

作　　者：张文玺[1] 王新明[2] 吉跃平 李栋[2] 刘杰[1] 王帅[2] 

机构地区：[1]江西省溧阳市人民医院骨科,213300 [2]江西省溧阳市人民医院放射科,213300

出　　处：《中华创伤骨科杂志》2017年第7期589-595,共7页Chinese Journal of Orthopaedic Trauma

基　　金：常州市卫生计生重大科技项目（ZD201510）;常州市卫生局计划项目（WZ201128）

摘　　要：目的探讨3D打印胫腓骨远端的骨折复原模型用于术前规划和设计。方法回顾性分析2015年10月至2016年9月治疗的35例胫腓骨远端骨折患者资料。所有患者均行双侧胫腓骨全长的CT扫描，获取Dicom数据，通过Mimics15．0软件将双侧胫骨上端距离膝关节5、10、15cm处做横截面，记录符号为PT5、PT10、PT15，并测量对比左侧与右侧长轴（LLvs．RL）、短轴（LSvs．RS）。通过Mimics15．0软件生成3D模型的STL文件，打印出实际尺寸的胫腓骨远端骨折部位和健侧胫腓骨镜像模型。在镜像模型上绘制骨折线并进行术前演练。术中采用术前预演的置入物，实际测量螺钉长度及摄片与术前预演对比。结果对胫骨近端的左、右侧3个层面（PT5、PT10、PT15）的长短轴进行数据汇总，按照每个层面的相同轴分组，每组数据及成对数据差值均符合正态分布，每组成对样本的相关系数均〉0．95，相关性极强。成对样本中PT5、PT10、PT15的LL与RL比较及Ls与RS比较差异均无统计学意义（P〉0．05）。35例患者均进行了手术治疗，术后复查x线片示置入物贴服程度及螺钉长度与术前设计符合，手术使用螺钉长度偏差均在容许范围，钢板贴服良好，内固定满意。结论健侧镜像模型作为骨折解剖复位后的模型进行术前预演及置入物的准备，具备一定的临床实用价值，而3个层面长、短轴对照使双侧相似性比较变得简单、有效，避免了直接采用健侧镜像模型进行术前规划的盲目性。Objective To explore a 3D printing model of fracture restoration which can be used in preoperative planning and design for distal tibiofibular fractures. Methods A retrospective analysis was performed of the 35 patients with distal tibiofibular fracture who had been treated from October 2015 to September 2016 at our department. Bilateral tibiofibular CT scan was performed in all the cases to obtain Dicom data. Using Mimics 15.0 software, cross sections were created at 5 cm, 10 cm and 15 cm above the knee joint at the bilateral upper tibiae and marked as PTS, PT10 and PT15. The long and short axles on the left and right sides were measured and compared （LL vs. RL; LS vs. RS）. After the STL files for 3D models were generated using Mimics 15.0 software, a real-sized 3D model of the distal tibiofibular fracture and a mirror model of the contralateral tibiofibula were printed. The fracture lines were drawn and preoperative manoeuvre was performed on the mirror 3D printed model. The real operation used the implants preoperatively designed; the actual screw lengths were measured and compared radiograpbically with those designed in the preoperative manoeuvre. Results All the data were collected of the long and short axles on the 3 cross-sections （PT5, PT10 and PT15） of the left and right sides of the proximal tibia. The samples were paired into 6 groups. The correlation coefficients of paired samples were greater than 0. 95, showing an ex- tremely strong correlation. The differences between the left and right sides showed no statistically significance in paired samples of LR-RL and LS-RS groups on PT5, PT10 and PT15 cross-sections （ P 〉 0. 05）. All the 35 cases received surgical operation. The postoperative X-ray review showed fine agreement between actual surgery and preoperative design in terms of screw length and accuracy. The deviations were in an allowable range, leading to satisfactory internal fixation. Confusions A mirror 3D model of the healthy side is of clinical value to some extent because it ca

关 键 词：踝关节 骨折固定术 内 3D打印技术 

分 类 号：R687.3[医药卫生—骨科学] TP391.73[医药卫生—外科学]