快速成型技术在复杂肱骨近端骨折治疗中的应用研究

Application of Rapid Prototyping Technology in the Proximal Humeral Comminuted Fracture

目的:通过与常规手术比较,探讨快速成型技术在复杂肱骨近端骨折手术治疗中的可行性和临床应用价值。方法:选择2012年9月-2014年6月间医院收治的27例复杂肱骨近端骨折(Neer三部分及四部分)临床患者(研究组13例,对照组14例),研究组患者进行CT扫描,将所获DICOM数据运用Mimi cs软件数据进行建模处理,再应用快速成型技术打印三维骨折模型,用于明确诊断及制定个性化手术方案,模拟手术过程,并按规划实施手术,术后对两组患者手术操作时间、术中出血量、术中透视次数、骨折愈合时间、肩关节Constant评分等进行统计学分析,并与术前规划在钉板系统位置、长度等方面进行比较。结果:快速成型所获得的肱骨近端骨折三维模型,可直观展现及任意方位观察骨折移位的方向、程度,用于手术前诊断、医患沟通、手术规划设计、数据测量、预选内固定物及模拟手术效果。本组27例均获随访,随访时间6-18个月。两组骨折愈合时间无明显差异(P>0.05)。研究组的手术操作时间、术中出血量、术中透视次数低于对照组,而肩关节Constant评分高于对照组(P<0.05)。结论:快速成型技术应用于复杂肱骨近端骨折的治疗临床可行性良好,通过该技术获得的肱骨近端骨折模型可清晰展示骨折情况,利于明确骨折分型,判断骨折损伤程度,有助于手术团队对复杂肱骨近端骨折的理解和术前手术方案的制定,便于医息沟通,可降低医患纠纷风险、提高手术效果、减少术中损伤。

Objective： To compare the operation with rapid prototyping technique and the conventional procedure for treatment of proximal humeral comminuted fractures. Methods： Twenty-seven patients with proximal humeral comminuted fracture who had been admitted to our hospital from September 2012 to June 2014 were divided into two groups randomly. Group A （research group） underwent 3-dimensional visualization, computer assistant simulation and rapid prototyping to get demonstration of individual fracture model before operation. Group B （control group） received only conventional operation.The therapeutic effects were evaluated by Constant scores and compared statistically for duration of operation, amount of bleeding, amount of intraoperative fluoroscopy and fracture healing time between the 2 groups. Results： The model of proximal humeral fractures with rapid prototypingtechnology can accurately reflect fracture characteristics, including fracture displacement direction and degree, and realize the individual preoperative operation design easily. All of 27 cases were followed up for 6~18 months. Constant scores of Group A were higher than Group B, and the duration of operation, amount of bleeding and intraoperative fluoroscopy were lower than Group B （P〈0.05）. There was no significant difference between two groups in fracture healing time （P〉0.05）. Conclusion： Rapid prototyping technology can shorten the operation time, reduce the risk of intraoperative injury, reduce medical disputes and improve operational efficiency for Proximal Humeral Comminuted fractures.