3D打印钛板塑形模板在髋臼骨折的可行性研究
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摘要
目的:设计3D打印髋臼骨折钛板塑形模板并初步应用,了解3D打印钛板塑形模板在髋臼骨折的可行性。方法:回顾2014年1月—2016年7月医院8例进行常规髋臼骨折手术患者的10块钛板,通过建立骨盆与钛板数字模型,测量钛板与髋臼骨面间平均间隙与最大间隙,以其平均值并作为技术标准。纳入2016年7月—2017年12月同意使用3D打印塑形模板辅助的髋臼骨折手术患者3例,共植入钛板6块。术前利用患者CT图像建立骨盆骨折数字模型,设计并3D打印得到钛板塑形模板,在术前比对模板完成钛板塑形,术中骨折复位后安装塑形好的钛板,术后复查CT重建骨盆钛板数字模型,测量"钛板与骨面的平均间隙""钛板与骨面最大间隙",与回顾标准比较。结果:3例患者使用的所有6块钛板术后测量"钛板与骨面平均间隙""钛板与骨面间隙最大值"均小于测量得到的标准。且两组钛板比较"钛板与骨面平均间隙""钛板与骨面最大间隙值"差异具有统计学意义(P<0.05)。结论:在现有技术条件下,使用3D打印钛板塑形模板在术前对髋臼钛板塑形具备可行性。
Objective: To design and apply the 3D printed templet for titanium plate used in acetabular fracture surgery, and explore the feasibility. Methods: From January 2014 to July 2016, 8 patients with acetabular fractures, which had operated in hospital and fixed with 10 titanium plates, were reviewed. The digital models of pelvis and plate were reconstructed from the postoperative CT images.The gap between the titanium plate and surface of acetabular was measured by model distance comparison, and the indicators, "the maximum gap size" and "the average gap size", were harvested. The average of these two indicators were calculated and regarded as a technical standard for further comparison. From July 2016 to July 2017, 3 patients with acetabular fractures implanted 6 titanium plates were included in this study. The digital model of damaged pelvis was reconstructed from the CT images of those wounded patients, and repaired by digital technique. The digital model of template for titanium plate was derived from the surface of the repaired pelvis. It was exported to a stereo lithography apparatus 3D printer and formed by 3D printing. Before operation the titanium plates were modified by comparison with the template, and implanted without other modifications in the operation. Then all patients underwent CT scan again. "The maximum gap size" and "the average gap size" of these three patients were measured by the same technique,and compared with the standard. Results: "The average gap size" and "the maximum gap size" between six titanium plates, implanted in 3 patients adopted templet before surgery, and bone surface are all less than the standard. And the differences of "the average gap size" and "the maximum gap size" between two samples of plates are significant(P <0.05). Conclusion: By the existent digital technique, nowadays, it is feasible to design and adopt 3D printed templet to modify the titanium plate before acetabular fracture operation.
Objective: To design and apply the 3D printed templet for titanium plate used in acetabular fracture surgery, and explore the feasibility. Methods: From January 2014 to July 2016, 8 patients with acetabular fractures, which had operated in hospital and fixed with 10 titanium plates, were reviewed. The digital models of pelvis and plate were reconstructed from the postoperative CT images.The gap between the titanium plate and surface of acetabular was measured by model distance comparison, and the indicators, "the maximum gap size" and "the average gap size", were harvested. The average of these two indicators were calculated and regarded as a technical standard for further comparison. From July 2016 to July 2017, 3 patients with acetabular fractures implanted 6 titanium plates were included in this study. The digital model of damaged pelvis was reconstructed from the CT images of those wounded patients, and repaired by digital technique. The digital model of template for titanium plate was derived from the surface of the repaired pelvis. It was exported to a stereo lithography apparatus 3D printer and formed by 3D printing. Before operation the titanium plates were modified by comparison with the template, and implanted without other modifications in the operation. Then all patients underwent CT scan again. "The maximum gap size" and "the average gap size" of these three patients were measured by the same technique,and compared with the standard. Results: "The average gap size" and "the maximum gap size" between six titanium plates, implanted in 3 patients adopted templet before surgery, and bone surface are all less than the standard. And the differences of "the average gap size" and "the maximum gap size" between two samples of plates are significant(P <0.05). Conclusion: By the existent digital technique, nowadays, it is feasible to design and adopt 3D printed templet to modify the titanium plate before acetabular fracture operation.
引文
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[14]毕春,纪晓希,汪方,等.弓状线上方髋臼区域准确置钉的三维重建及数字化测量研究[J].中华创伤骨科杂志,2014,16(5):371-376.
[15]马清伟,李危石,孙卓然,等.中老年人群脊柱-骨盆矢状位参数及其序列拟合关系[J].中国脊柱脊髓杂志,2016,26(2):146-150.
[16]Maini L,Sharma A,Jha S,et al.Threedimensional printing and patient-specific precontoured plate:future of acetabulum fracture fixation?[J].Eur J Trauma Emerg Surg,2016(26).
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[19]Zeng CJ,Tan XY,Huang HJ,et al.Clincial effect of 3D printing-assisted minimal invasive surgery through a small incision lateral to the rectus abdominis for pelvic fracture[J].Nan Fang Yi Ke Da Xue Xue Bao,2016,36(2):220-5.
[20]周坚锋,苏秀云,李建涛,等.三维重建技术塑形髋臼后柱钢板的效果观察[J].山东医药,2016,56(9):53-54.
[2]张伟,王庆雷,张铁良,等.3D打印技术在移位髋臼骨折合并不稳定型骨盆后环损伤治疗中的应用[J].中华创伤骨科杂志,2017,19(8):696-702.
[3]Behrendt D,Mutze M,Steinke H,et al.Evaluation of 2D and 3D navigation for iliosacral screw fixation[J].Int J comput Assist Radiol surg,2012,7(2):249-255.
[4]王鉴顺,蔡乐益,楼溢程,等.3D打印技术辅助下空心螺钉微创固定治疗不稳定型骨盆骨折[J].中华创伤骨科杂志,2017,19(3):240-244.
[5]章莹,李宝丰,王新宇,等.术前3D打印技术模拟复杂骨盆骨折手术提高疗效的可行性研究[J].中华创伤骨科杂志,2015,17(1):29-33.
[6]周游,徐小山,李川,等.3D打印导板在Bernese髋臼周围截骨术中的应用[J].中华创伤骨科杂志,2016,18(1):17-23.
[7]李明,孙亮,马腾,等.3D打印快速成型技术在髋臼骨折分型及年轻医生培养中的应用[J].中华创伤骨科杂志,2017,19(2):140-145.
[8]Ahmed Zemirline,Vincent Agnus,Luc Soler,et al.Augmented Reality Based Navigation System for Wrist Arthroscopy:Feasibility[J].Journal of wrist surgery,2013(4):294-298.
[9]Tabrizi,Leila-Besharati,Mahvash,Mehran.Augmented reality-guided neurosurgery:accuracy and intraoperative application of an image projection technique[J].Journal of neurosurgery,2015(1):206-211.
[10]Cip J,Widemschek M,Luegmair M,et al.Conventional versus computer-assisted technique for total knee arthroplasty:a minimum of 5-Year follow-up of 200 patients in a prospective randomized comparative rial[J].Arthroplasty,2014,29(9):1795-1802.
[11]梁爱军,姚庆强,刘帅,等.基于三维可视化与计算机辅助设计的全膝关节置换术[J].中国数字医学,2017,12(9):93-97.
[12]张帆,潘磊,薛厚军,等.侧后路椎间孔镜穿刺定位器的设计与模拟[J].中国数字医学,2016,11(6):9-11,32.
[13]张帆,潘磊,薛厚军,等.经皮侧后路椎间孔镜手术穿刺定位装置的研制[J].中国医学装备,2016,13(8):1-3.
[14]毕春,纪晓希,汪方,等.弓状线上方髋臼区域准确置钉的三维重建及数字化测量研究[J].中华创伤骨科杂志,2014,16(5):371-376.
[15]马清伟,李危石,孙卓然,等.中老年人群脊柱-骨盆矢状位参数及其序列拟合关系[J].中国脊柱脊髓杂志,2016,26(2):146-150.
[16]Maini L,Sharma A,Jha S,et al.Threedimensional printing and patient-specific precontoured plate:future of acetabulum fracture fixation?[J].Eur J Trauma Emerg Surg,2016(26).
[17]Zeng C,Xing W,Wu Z,et al.Acombination of three-dimensional printing and computer-assisted virtual surgical procedure for preoperative planning of acetabular fracture reduction[J].Injury,2016,47(10):2223-2227.
[18]仇道迪,周东生,许维澄,等.3D打印技术在陈旧性骨盆髋臼骨折治疗中的应用[J].中华创伤骨科杂志,2017,19(7):624-629.
[19]Zeng CJ,Tan XY,Huang HJ,et al.Clincial effect of 3D printing-assisted minimal invasive surgery through a small incision lateral to the rectus abdominis for pelvic fracture[J].Nan Fang Yi Ke Da Xue Xue Bao,2016,36(2):220-5.
[20]周坚锋,苏秀云,李建涛,等.三维重建技术塑形髋臼后柱钢板的效果观察[J].山东医药,2016,56(9):53-54.
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