3D打印仿真腰椎手术模型的构建与评估  

Construction and evaluation of 3D printing simulation model for lumbar surgery

作　　者：袁德超 吴超[1,2] 邓佳燕[2] 王翔宇 李涛[1] 谭伦[1] 王伟[3] 罗敏[3] Yuan Dechao;Wu Chao;Deng Jiayan;Wang Xiangyu;Li Tao;Tan Lun;Wang Wei;Luo Min(Department of Orthopedics,Zigong Fourth People’s Hospital,Zigong 643000,Sichuan Province,China;Digital Medical Center,Zigong Fourth People’s Hospital,Zigong 643000,Sichuan Province,China;Department of Radiology,Zigong Fourth People’s Hospital,Zigong 643000,Sichuan Province,China)

机构地区：[1]自贡市第四人民医院骨科,四川省自贡市643000 [2]自贡市第四人民医院数字医学中心,四川省自贡市643000 [3]自贡市第四人民医院放射科,四川省自贡市643000

出　　处：《中国组织工程研究》2020年第12期1870-1874,共5页Chinese Journal of Tissue Engineering Research

基　　金：四川省重点科技计划项目(2016JY0108)，项目负责人：吴超;自贡市重点科技计划创新苗子项目(2018CXMZ05)，项目负责人：袁德超;自贡市重点科技计划项目(2017RK02)，项目负责人：谭伦~~

摘　　要：背景:3D打印骨骼模型广泛应用于临床教学、模拟手术培训,但对于构建软组织的重视程度不够,仿真性差,不能体现软组织暴露过程。目的:探讨基于3D打印技术构建仿真腰椎手术模型,用于低年资骨科医师腰椎弓根螺钉置钉手术培训的可行性。方法:基于3D打印技术同比例打印腰椎实体模型,并用橡皮泥、布料包裹构建仿真腰椎手术模型。30名低年资骨科住院医师在该仿真模型上单独进行腰椎弓根螺钉置钉手术,每天操作培训1次,连续操作10 d,记录手术操作时间,术后CT扫描评估置钉准确率。通过对比操作者前期(前5次)与后期(后5次)的操作时间、置钉准确率,并进行统计学分析。研究经自贡市第四人民医院伦理委员会审核通过。结果与结论:①操作者前期(前5次)平均手术时间为(100.00±12.67)min,后期(后5次)平均手术时间为(83.50±10.14)min,差异有显著性意义(t=20.67,P=0.00);②前期手术置钉成功率(包括Ⅰ级、Ⅱ级置钉)为88.53%,失败率(Ⅲ级置钉)为11.47%;后期手术置钉成功率为97.47%,失败率为2.53%,前、后期成绩对比差异有显著性意义(χ2=20.68,P=0.00);③结果说明,基于3D打印技术构建的仿真腰椎手术模型仿真性高,可行性强,可用于低年资骨科医师腰椎弓根螺钉置钉的手术培训。BACKGROUND:3D printed bone model was widely used in clinical teaching and simulated surgery training,but it did not pay enough attention to the construction of soft tissue,and the simulation was poor,which cannot reflect the soft tissue exposure process.OBJECTIVE:To explore the feasibility of constructing a simulated lumbar spine surgery model based on 3D printing technology for the training of lumbar pedicle screw placement in junior orthopedic surgeons.METHODS:The solid model of the lumbar spine was printed at the same proportion based on 3D printing technology,and the model of simulated lumbar spine surgery was constructed with plasticine and cloth.Thirty orthopedic residents performed lumbar pedicle screw placement alone on the simulated model,and performed once a day for 10 consecutive days.They recorded the operation time,and evaluated the accuracy of screw placement by postoperative CT scan.By comparing the operation time and screw placement accuracy of the operators in the early stage(the first 5 times)and the later stage(the last 5 times),all above parameters were statistically analyzed.This study was approved by the Ethics Committee of Zigong Fourth People’s Hospital.RESULTS AND CONCLUSION:(1)In the early stage(the first 5 times),the average operation time was(100.00+12.67)minutes.In the later stage(the last 5 times),the average operation time was(83.50+10.14)minutes,and the difference was statistically significant(t=20.67,P=0.00).(2)The success rate of former screw placement(including grade I and II screw placement)was 88.53%,and the failure rate(grade III screw placement)was 11.47%.The success rate and failure rate of latter screw placement were 97.47%and 2.53%,respectively,with statistically significant difference(χ2=20.68,P=0.00).(3)The simulated model of lumbar spine surgery based on 3D printing technology has high simulation and feasibility,and can be used for the training of lumbar pedicle screw placement in junior orthopedic surgeons.

关 键 词：3D打印技术 仿真 腰椎手术模型 手术培训 低年资骨科医师 

分 类 号：R459.2[医药卫生—治疗学] R496[医药卫生—临床医学]