3D打印手术导板结合桥接内固定系统异型块治疗股骨复杂骨折  

3D printed guide and special-shaped bridge combined fixation system for treatment of complex femoral fractures

作　　者：王文 左贵来 王凡 仲伟波 张谦 

机构地区：[1]山东省千佛山医院骨创伤外二科,山东济南250014

出　　处：《中国矫形外科杂志》2017年第22期2086-2090,共5页Orthopedic Journal of China

摘　　要：[目的]评估3D打印手术导板结合桥接内固定系统异型块技术治疗股骨复杂骨折。[方法]采用此技术治疗股骨粉碎性闭合性复杂骨折患者7例,年龄26~45岁,平均35岁。患肢进行螺旋CT扫描后,采用Mimics软件处理DICOM数据。骨折虚拟复位后,将股骨桥接棒远近段异型块STL文件导入,设计并打印远近段手术导板。术中暴露出股骨远近端皮质,在导板引导下置放桥接棒异型块,连接桥接棒完成间接复位骨折。同时异型块的螺钉也能固定髁部或粗隆间骨折。采用Warden的4-point radiographic scoring system对术后1个月的X线片骨折愈合骨痂评分程度进行评分。[结果]7例完全采用了计划固定方法,患者术中采用的异型块位置与桥接棒长度均与术前计划一致。术中C型臂X线机透视及术后随访X线片及CT显示7例均达到了生物学复位。无明显短缩及旋转移位。术后1个月随访见股骨骨折部均出现明显骨痂生长。Warden评分均为2分。[结论]该方法能够顺利完成股骨全长骨折固定,同时缩短手术时间,骨折段达到生物学固定,术后1个月骨痂生长明显。[Objective] To evaluate the technique of 3D printed guide and special-shaped bridge combined fixation syslem （BCFS） for treatment of complex clnsed femoral fracture. [Methods] Seven patients with complex femoral fracture were surgical- ly treated with the abovementioned techniques. After spiral CT scans of injured limh taken, the DICOM data of spiral CT were processed with Mimics software to virtually reduce the fracture. As importing STL file of special-shape BCFS, distal and prnxi- real surgical guides were designed and made by the 3D printer. During surgical operation, only the proximal and distal cortical bone of the f^mur were exposed, then, the special-shaped BCFS was inserted under the guidance, afterward, indirect reduetion the fracture was performed with assistance of the bridging rods, finally, the femoral condyle and intertrochauteric area were fixed with the special-shaped blocks of BCFS by screws. According to 4-point radiographic scoring system of Warden, postoperative X-ray was evaluated a month after operation. [Results] All of the 7 patients got biological reduction and fixation without shorten- ing and rotational displacement with the special-shaped BCFS, which co,npletely met the preoperative design in position of the speeial-shaped blocks and length of the rods. A significant growth of callus was noted around the femoral fracture a month after the operation, associated with Warden scores of 2 in all of the patients. [Conclusion] For treatment of complex femoral frac- tures, 3D printed guides combined with special -shape of （BCFS） have obvious advantages of effective indirect reduction and fixation fracture involving full length of the femur, simplifieation of surgical manipulation with opt, ration time of 1.5 hours on average.

关 键 词：复杂股骨骨折 桥接内固定系统 异型块 3D打印技术 手术治疗 

分 类 号：R687.3[医药卫生—骨科学]