-
髋臼骨折手术多由高能量损伤所致,是创伤骨科里难度最大的[1]。传统手术方法为经髂腹股沟入路结合后外侧入路切开复位钢板内固定,前后手术切口长达20cm,创伤大,手术风险高[2]。随着数字医学技术的发展与推广,术前通过三维重建模型进行骨折复位、内固定模拟操作可提高手术成功率[3]。但三维图像并不能完全给人直观、立体感觉,影响手术方案的制定及医患双方沟通。3D打印技术是以数字模型文件为基础,运用粉末状金属或塑料等可黏合材料,通过逐层打印方式来构造物体的快速成型技术,可大大节省传统模具加工的繁琐步骤。其在骨科临床上的应用可快速为病人定制个性化不规则骨折模型,帮助临床医师准确直观判断骨折移位方向及程度,合理规划手术方案,使手术更精准、安全[4-5]。本研究应用3D打印技术结合术前虚拟手术设计,进行真实、准确的术前手术模拟以及术中规范、有效地执行手术方案,从基础与临床两方面探讨髋臼骨折微创化、精确化、个性化治疗的可行性。
打印与虚拟手术设计在髋臼骨折手术治疗中的应用
Application value of printing and virtual surgery design in the treatment of acetabular fracture
-
摘要:
目的 从基础与临床两方面探讨3D打印与虚拟手术设计在髋臼骨折手术治疗中的应用可行性。 方法 基础部分选择36例髋臼骨折病人,临床部分选择13例髋臼骨折病人,应用3D打印技术结合术前虚拟手术设计,根据髋臼骨折病人骨盆薄层CT扫描数据进行三维重建、虚拟骨折块分离、虚拟手术复位、虚拟内固定植入模拟髋臼骨折手术,为病人制定个性化的手术方案,进行临床手术治疗。 结果根据病人骨盆薄层CT扫描数据成功获得高精度虚拟复位模型,虚拟模拟骨折块分离、复位、内固定置入等步骤确定钢板植入位置、螺钉植入方向、螺钉植入长度,制定个性化、最优化手术方案设计,并结合虚拟手术设计完成3D模拟手术;基础实验部分病人钢板位置均与数字化设计高度一致,螺钉方向与数字化设计高度吻合,虚拟手术设计螺钉长度与3D模拟手术螺钉长度比较差异无统计学医院(P>0.05);临床实验部分病人均按照虚拟手术设计成功完成手术,术后与虚拟手术设计钢板、螺钉位置及数量高度一致,虚拟手术设计螺钉长度与临床手术螺钉长度比较差异无统计学意义(P>0.05)。 结论 3D打印与虚拟手术设计可为髋臼骨折病人制定最优化、个性化的手术方案,有效提高手术精确性与安全性,应用可行性高。 Abstract:Objective To explore the application feasibility of 3D printing and virtual surgery design in the treatment of acetabular fractures from both basic and clinical aspects. MethodsThirty-six patients with acetabular fractures were selected in the basic part, and 13 patients with acetabular fractures were selected in the clinical part.The 3D printing combined with preoperative virtual surgery design was applied.The three-dimensional reconstruction, virtual fracture fragments separation, virtual surgical reduction and virtual internal fixation implantation were performed according to pelvic thin-slice CT scan data of acetabular fracture patients to simulate acetabular fracture surgery for developing a personalized surgical plan for patients to conduct clinical surgical treatment. Results A high-precision virtual reduction model was successfully obtained according to the patient′s pelvic thin-slice CT scan data.The fracture block separation, reduction, internal fixation implantation and other steps were virtually simulated to determine the plate placement position, screw implantation direction and screw implantation length.The individualized and optimized surgical program were drawn up, the 3D simulation surgery was completed by combining with virtual surgery design.In the basic experimental part, the patient′s steel plate position and screw direction were highly consistent with the digital design.The difference of the screw length between virtual surgery design and 3D simulation surgery was not statistically significant(P>0.05).In the clinical experiment, the operations in some patients were successfully completed according to the virtual surgery design, the positions and quantities of the plates and screws were highly consistent with the virtual surgery design, and the difference in the length of screw between the virtual surgery design and clinical operation was not statistically significant(P>0.05). ConclusionsThe 3D printing and virtual surgery design can provide the optimal and personalized surgical solutions for patients with acetabular fractures, which can effectively improve the accuracy and safety of surgery, the application feasibility is high. -
Key words:
- 3D printing /
- virtual surgery design /
- acetabular fracture surgery
-
[1] NⅡKURA T, SUGIMOTO M, LEE SY, et al. Tactile surgical navigation system for complex acetabular fracture surgery[J]. Orthopedics, 2014, 37(4): 237. doi: 10.3928/01477447-20140401-05 [2] DE BELLIS UG, LEGNANI C, CALORI GM. Acute total hip replacement for acetabular fractures: a systematic review of the literature[J]. Injury, 2014, 45(2): 356. doi: 10.1016/j.injury.2013.09.018 [3] 王雨辰, 马勇, 俞伟忠, 等. 计算机虚拟复位结合3D打印技术在髋臼骨折中的临床应用[J]. 中国骨伤, 2017, 30(7): 627. doi: 10.3969/j.issn.1003-0034.2017.07.009 [4] ZENG J, HUANG WH, HUANG HJ, et al. Laparoscopic acetabular fracture fixation after three-dimensional modelling and printing[J]. Indian J Orthop, 2017, 51(5): 620. doi: 10.4103/0019-5413.214215 [5] 罗斌, 朱爱萍, 刘家国. 髋臼骨折术前规划中3D打印技术虚拟手术模拟的应用[J]. 中国临床研究, 2018, 31(5): 597. [6] 陆俭军, 谭海涛, 陆声榆, 等. 3D打印技术辅助手术治疗髋臼双柱骨折的临床疗效分析[J]. 广西医科大学学报, 2017, 34(1): 28. [7] CHEN X, CHEN X, ZHANG G, et al. Accurate fixation of plates and screws for the treatment of acetabular fractures using 3D-printed guiding templates: an experimental study[J]. Injury, 2017, 48(6): 1147. doi: 10.1016/j.injury.2017.03.009 [8] ZENG C, XING W, WU Z, et al. A combination of three-dimensional printing and computer-assisted virtual surgical procedure for preoperative planning of acetabular fracture reduction[J]. Injury, 2016, 47(10): 2223. doi: 10.1016/j.injury.2016.03.015 [9] 李富涛, 李焰, 马杰, 等. 计算机辅助虚拟手术设计结合3D打印技术在颌骨重建的应用研究[J]. 创伤外科杂志, 2017, 19(9): 657. doi: 10.3969/j.issn.1009-4237.2017.09.005 [10] CHANA-RODRÍGUEZ F, MAÑANES RP, ROJO-MANAUTE J, et al. 3D surgical printing and pre contoured plates for acetabular fractures[J]. Injury, 2016, 47(11): 2507. doi: 10.1016/j.injury.2016.08.027 [11] 胡林勇, 陈秋生, 钟美莲, 等. 3D打印在髋臼骨折并骨盆骨折中的临床应用[J]. 中华实用诊断与治疗杂志, 2016, 30(9): 867. [12] 吴毅, 吴章林, 孙永建, 等. 3D打印技术在髋臼骨折个性化导航模块设计中的应用[J]. 分子影像学杂志, 2016, 39(4): 379. doi: 10.3969/j.issn.1674-4500.2016.04.11 [13] 王志标, 伯宇, 马腾, 等. 3D打印技术在骶骨骨折手术中的应用[J]. 宁夏医科大学学报, 2017, 39(4): 479. [14] 李新春, 康麟, 庞渊. 3D打印技术在Pilon骨折手术治疗中的应用[J]. 新疆医科大学学报, 2015, 48(4): 471. doi: 10.3969/j.issn.1009-5551.2015.04.020 [15] 黄华军, 张国栋, 欧阳汉斌, 等. 基于3D打印技术的复杂胫骨平台骨折内固定手术数字化设计[J]. 南方医科大学学报, 2015, 35(2): 218. doi: 10.3969/j.issn.1673-4254.2015.02.12