3-D打印技术在儿童青少年胫骨近远端骺损伤骨折的应用  

Application of 3-D printing technique for proximal and distal tibial epiphyseal injuries in children and adolescent

作　　者：王瑜[1] 马雅昌 朱雅文 杨朝昕 穆怀昭[1] 金宇[1] WANG Yu;MA Ya-Chang;ZHU Ya-wen;YANG Zhao-xin;MU Huai-zhao;JIN Yu(Institute of Postgraduate,Chengde Medical College,Chengde 067000,Chin;Department of Traumatic Orthopaedics,The Affiliated Hospital,Chengde Medical Col-lege,Chengde 067000,China)

机构地区：[1]承德医学院附属医院创伤骨科,067000

出　　处：《中国矫形外科杂志》2018年第20期1903-1906,共4页Orthopedic Journal of China

摘　　要：[目的]探究3-D打印技术在儿童及青少年胫骨近远端骺损伤骨折手术中应用的可行性。[方法]回顾分析本院2013年1月～2016年1月收治的18例胫骨近端骺损伤骨折及15例胫骨远端骺损伤骨折患者临床资料。所有患者术前均收集CT数据,在Mimics软件中进行骨折三维重建,打印出1:1实体模型,并在3-D模型上行模拟手术设计内固定方案,术中操作按术前计划完成。术后支具制动,早期功能锻炼。采用Hohl和Luck膝关节评分、Helfet踝关节功能评分比较双侧肢体生长长度,评价临床效果。[结果]所有患者术后随访12～18个月,平均(16.37±1.96)个月,所有患者均获得骨性愈合,术后12个月改良Hohl和Luck膝关节评分优良率为100%(优15、良3),踝关节功能Helfet评分优良率为100%(优13、良2),术后复查时行双下肢全长轴线片对比,未发生骨骺早闭、关节内外翻及关节不稳定等并发症;术后12个月患肢活动度及生长长度与健侧比较,差异无统计学意义(P>0.05)。[结论] 3-D打印技术对青少年胫骨近远端骺损伤骨折的诊治有较好的临床指导作用。[Objective] To explore the feasibility of 3-D printing technique for the treatment of proximal and distal tibia epiphyseal injuries in children and adolescent. [Methods] A retrospective study was conducted on the clinical data of surgical treatment using 3-D printing technique in 18 patients with proximal tibial epiphyseal injuries and 15 with distal tibial epiphyseal injuries in our hospital from January 2013 to January 2016. Before operation, the CT data were treated with Mimics software for three-dimensional reconstruction of the physeal fracture to print out a 1：1 solid model. The 3-D model was used to simulate surgical operation and internal fixation of physeal fracture to make the personalized operation plan. During operation, the physeal fractures were reduced and fixed according to the preoperative plan. After operation, early active functional exercise was encouraged with brace protection. The clinical consequences were evaluated by the modified Hohl and Luck knee score for knee function, Helfet score for ankle function and comparison of limbs growth between two sides. [Results] All patients were followed up for 12 to 18 months with a mean of（16.37±1.96） months. At the latest follow up, bony healing achieved in all patients.In term of Hohl and Luck knee score at 12 months after surgery, 15 adolescent of the 18 with proximal tibial epiphyseal injuries was graded as excellent, while the remaining 2 graded as good, associated with the excellent and good rate of 100%. In addition,among the 15 adolescent with distal tibial epiphyseal injuries, 13 were graded as excellent and 2 as good with excellent and good rate of 100% regarding to Helfet ankle score. During follow up, the full-length radiographs of the lower extremities revealed no complications, such as premature epiphyseal closure, knee valgus and joint instability, happened in anyone of them.No significant differences in the range of motion and limb length between two sides were noticed at 12 months postoperatively（P〈0.05）. [Conclusion] The

关 键 词：3D打印 儿童 骺板 模拟手术 

分 类 号：R683.42[医药卫生—骨科学]