3D打印技术在Sanders Ⅲ型跟骨骨折内固定手术设计中的应用  

3D-printing in preoperative design of internal fixation for Sanders m calcaneal fractures

作　　者：何藻鹏[1] 李卫[1] 刘金伟[1] 张国栋[2] 郑玉东[1] 曾迪藩 刘东波[1] 黄文华[2] 

机构地区：[1]广东省医学3D打印应用转化工程技术研究中心顺德基地,广东省佛山市顺德区乐从医院,528315 [2]南方医科大学基础医学院解剖学教研室,广州510515

出　　处：《中华创伤骨科杂志》2017年第9期791-796,共6页Chinese Journal of Orthopaedic Trauma

基　　金：广东省科技计划重大项目（20158010125005）;中国南方智谷（2015CXTD05）;佛山市科技局医学类科技攻关项目（2015AB001923）

摘　　要：目的探讨3D打印技术结合数字化技术在Sande~Ⅲ型跟骨骨折内固定手术方案设计中的应用方法与效果。方法对2015年11月至2016年10月收治的12例SandeⅢ型跟骨骨折患者资料进行回顾性分析，男7例，女5例；年龄23—53岁，平均38．7岁；双侧跟骨薄层CT扫描数据导入Mimics软件中进行骨折三维重建、虚拟复位、数字化手术设计，用3D打印技术制作1：1大小的跟骨骨折实体模型，制作钉道导航模块，进行接骨板预塑形与模拟手术。根据术前规划进行手术，术后对跟骨形态学参数进行评价，将术后效果与术前数字化设计效果进行比较。结果12例患者手术时间为60—90min，平均77．9min。术后随访时间4—8个月，平均6．2个月；患者均无切口软组织并发症发生。术后1个月B6hler角（32．6°±3．6°）、Gissane角（123．9°±9．5°）较术前（12．40±2．10、143．90±7．80）改善，差异均有统计学意义（P〈0．001）。跟骨外形与术前复位模型相仿，内固定位置、钉道方向与术前设计接近。术后3个月Maryland评分平均为87．8分，优良率为91．7％。结论该技术从数字化设计转化出真实手术工具，有助实现SandeⅢ型跟骨骨折精准手术设计。Objective To investigate the application of 3D-printing and digital technology in the preoperative design of internal fixation for intra-articular calcaneal fractures. Methods Thin-layer CT images of bilateral calcanei were collected from 12 patients who had been treated for calcaneal fracture of Sanders type Ⅲ from November 2015 to October 2016. They were 7 men and 5 women, aged from 23 to 53 years （average, 38.7 years） . The images were uploaded into Mimics software for 3D reconstruction, virtual reduction and digital surgical design. Real-size calcaneal models and navigation modules were produced using 3D printing technology for plate preshaping and surgical simulation. The operations were carried out according to preoperative design. The postoperative calcaneal morphological parameters were evaluated. Comparisons were made between postoperative results and preoperative digital design. Results The operating time for the 12 patients ranged from 60 to 90 minutes, averaging 77.9 minutes. Their follow-ups ranged from 4 to 8 months, averaging 6. 2 months. No complications affecting their soft tissues happened. The postoperative Btihler angle （32.6° ± 3.6°） and Gissane angle （ 123.9° ±9. 5°） were significantly improved compared with the preoperative values （ 12.4 ° ± 2. 1 ° and 143.9° ± 7.8 °） （ P 〈 0. 001 ）. The shape of postoperative calea- neus was similar to that of the preoperative reduction model. The internal fixation locations and nail directions were in agreement with the preoperative design. Their average Maryland score was 87.8 and excellent to good rate 91.7%. Conclusion This technique can transform a digital design for intra-articular calcanealfracture into real operation tools to help realize a precise surgical design for such fractures.

关 键 词：跟骨 骨折 骨折固定术 内 3D打印 术前规划 

分 类 号：R687.3[医药卫生—骨科学]