快速成型技术辅助足趾移植再造拇指的临床应用  

Clinical application of rapid prototyping assisted toe transplantation for thumb reconstruction

作　　者：古汉南 古小玲 郭淑女 陈瑶 王克列 袁婷 张子清 GU Hannan;GU Xiaoling;GUO Shunv(Department of Hand Surgery,The Longgang Orthopedics Hospital of Shenzhen City,Shenzhen,Guangdong,518116,China)

机构地区：[1]深圳市龙岗区骨科医院手外科

出　　处：《实用手外科杂志》2019年第4期377-380,共4页Journal of Practical Hand Surgery

基　　金：深圳市科技计划项目(项目编号：JCYJ20160429104231738)

摘　　要：目的拟通过3D技术,为术前获取供区血管、骨组织的活体解剖图像,解决因血管变异导致的手术困难及盲目性,将传统"开放-观察-手术"的模式改变为"观察-开放-手术"模式。方法选取2016年6月-2018年6月收治的30例手指缺损患者资料进行分析,按照随机对照法分为观察组和对照组,每组各15例,两组病例均实施规范化再造并随访总结,观察组利用Mimics软件进行三维重建,并镜像模型相配准,对配准后模型进行三维测量,测量形态参数,对测量结果进行SPSS统计分析。结果 30例手指缺损再造手术过程顺利,指体均成活良好,术后均获5~12个月随访。采用3D打印技术的观察组手指缺损再造手术时间明显缩短、手术出血量明显减少,两组比较差异有统计学意义(P<0.05);两组术后再造指功能优良率比较,差异无统计学意义(P>0.05);两组术后再造指外观优良率比较,差异有统计学意义(P<0.05)。结论采用3D打印技术,建立手指模型,并由此模型复制并精准地覆盖于供区的皮肤、骨关节,由此所切取的供区组织更精准,使再造指更逼真,同时尽可能减轻供区无谓损伤,缩短手术时间,减少出血量及并发症,提高手术效率及功能和外观的优良率,为手指部分缺损再造手术提供一种规范化、精准化、个性化的方法。Objective T o obtain the vivo anatomical images of blood vessels and bone tissues of donor site before operation by 3 D technology, and to solve the difficulties and blindness caused by vascular variation, the traditional "open-observation-operation" mode was changed to "observation-open-operation" mode. Methods Fifteen cases of experimental group and 15 cases of routine group were reconstructed and followed up. Three-dimensional reconstruction was performed by Mimics software,and mirror model was matched. Three-dimensional measurement of the model was made after registration, and the morphological parameters were measured. SPSS statistical analysis was carried out on the measured results. Results Compared with 15 cases of experimental group and 15 cases of routine group, the effect of reconstruction of finger defect in experimental group was compared. The operation time of reconstruction of finger defect in experimental group using 3 D printing technology was significantly shortened, the amount of bleeding was significantly reduced, the rate of functional excellence was not statistically significant(P >0.05), and the rate of appearance excellence was higher(P <0.05).Conclusion Using 3 D printing technology, finger model is established, and then the model is replicated and can accurately cover the skin and bone joints of the donor area. The tissue of the donor area obtained from this model is more precise, which made the reconstructed finger more realistic. Meanwhile, the needless injury of the donor area is reduced as much as possible, the operation time and bleeding volume and complications are reduced, and the excellent rate of operation efficiency, function and appearance is improved. This reconstruction provides a standardized, precise and personalized method.

关 键 词：3D打印技术 数字医学技术 手指部分缺损再造手术 

分 类 号：R658.3[医药卫生—外科学]