3D打印镜像模型与分割模型在髌骨骨折术前规划中的应用研究  

Application of 3D printing mirror models and segmentation models in preoperative planning for patellar fractures

作　　者：张文玺[1] 周金华[1] 刘杰[1] 葛曙光 Zhang Wenxi;Zhou Jinhua;Liu Jie;Ge Shuguang(Department of Orthopaedics,Liyang City People's Hospital,Changzhou 213300,China)

机构地区：[1]江苏省溧阳市人民医院骨科,常州213300

出　　处：《中华创伤骨科杂志》2022年第8期693-699,共7页Chinese Journal of Orthopaedic Trauma

基　　金：常州市卫生计生重大科技项目(ZD201510,ZD201927)。

摘　　要：目的探讨3D打印镜像模型和分割模型在髌骨骨折术前规划中的应用情况。方法回顾性分析2016年1月至2020年8月江苏省溧阳市人民医院骨科采用2种3D打印模型进行术前规划的46例髌骨骨折资料。男26例,女20例;年龄19~79岁,平均51.5岁。骨折均为AO分型C型。根据实体模型设计要求,将具备双侧下肢DICOM数据的患者归为镜像模型组(24例),仅有单侧下肢CT扫描DICOM数据的患者归为分割模型组(22例)。镜像模型组患者需行双侧膝关节及超过15 cm的胫骨近端CT扫描,分割模型组仅需要患侧膝关节CT扫描,分别提取原始DICOM数据导入Mimics 19.0软件。镜像模型组患者采用"三层面长短轴对照"方法进行对称性判断后,形成骨折原始模型和镜像模型并分别打印,术中参考镜像模型绘制的骨折线寻找形态一致骨折块,予以拼合与固定。分割模型组骨折块分割成独立实体,转化为STL文件后,分别打印,并将骨块按顺序拼合与固定。术后均摄X线片并记录两组患者的模拟手术时间、术后1个月膝关节疼痛视觉模拟评分(VAS)和术后1、6个月B?stman评分。结果所有患者术后获6~24个月(平均13.6个月)随访。对于呈粉碎性、存在压缩和嵌插的骨折患者,仅适宜采用镜像模型进行术前规划;对于无嵌插、无压缩、无粉碎性的骨折,两种模型都适宜;而存在双侧同部位骨折、小儿麻痹症、一侧肢体缺如的、曾有过陈旧性骨折的患者,适宜采用分割模型进行术前规划。镜像模型组患者采用"三层面长短轴对照"进行双侧对照,两侧的3个层面共6组数据差异均无统计学意义(P>0.05)。分割模型组和镜像模型组患者术前模拟手术时间分别平均为11.2、9.2 min,术后1个月VAS评分均<3分;术后1、6个月B?stman评分均>20分。结论健侧髌骨镜像模型可以作为患侧的骨折复原模型进行使用,但严重退变者需预先验证对称性。3D打印镜像模型和分�Objective To explore the application of 3D printing mirror models and segmentation models in preoperative planning for patellar fractures.Methods Retrospectively analyzed were the data of 46 patellar fractures which had been treated at Department of Orthopedics,Liyang City People's Hospital from January 2016 to August 2020 using 3D printing mirror models and segmentation models in preoperative planning.There were 26 males and 20 females,aged from 19 to 79 years(average,51.5 years).All the fractures belonged to AO type C.According to the design requirements of a solid model,the patients with DICOM CT data of bilateral lower extremities were assigned into the mirror model group(24 cases)while those with DICOM CT data of only a unilateral lower extremity into the segmentation model group(22 cases).In the mirror model group,CT scans of bilateral knee joints and the proximal tibia exceeding 15 cm were required,while in the segmentation model group,CT scans of only the affected knee joint were required.The original DICOM data were extracted and imported into software Mimics 19.0.In the mirror model group,after the"three-level long-short axis control"method was used to judge the symmetry,the original fracture model and the mirror model were created and printed respectively.During the operation,the fracture line drawn by the mirror model was used to find the fracture fragments with a similar shape which were to be assembled and fixated.The fracture fragments in the segmentation model group were divided into independent entities,converted into STL files and printed separately before the bone fragments were assembled and fixated in sequence.X-ray films were taken after operation.Recorded were the simulated operation time,visual analog scale(VAS)of the knee joint at one month after operation,and Böstman scores at one and 6 months after operation.Results All patients were followed up for 6 to 24 months(mean,13.6 months).In preoperative planning,only the mirror model was suitable for patients with comminuted fracture with co

关 键 词：髌骨 骨折固定术 内 成像 三维 3D打印 镜像模型 分割模型 术前规划 

分 类 号：R687.3[医药卫生—骨科学]