3D打印技术在骨盆骨折修复中的应用

Application of 3D printing technology in the repair of pelvic fracture

背景:目前通过3D打印技术进行术前规划已经成为一种发展趋势,并且在骨肿瘤切除、颌面外科都有很好的应用,但应用于骨折修复前规划的报道还很少。目的:探讨在骨盆骨折修复术前评估、规划及修复过程中3D打印技术的应用价值。方法:骨盆骨折患者于修复术前行CT扫描断层图像,应用3D技术打印患者1∶1骨盆模型,并进行修复入路选择、切口暴露范围设计、骨折复位设计、钢板预置入位置、钢板最佳塑性设计、螺钉长度测量、螺钉进入方向设计等术前预操作。修复术后随访期间测定患者骨盆骨折复位Matta评分及骨盆功能Majeed评分。结果与结论:患者手术时间55-130 min,平均(84.75±20.15)min;术中出血量200-800 m L,平均(417.00±173.58)m L。术后均无切口感染、骨折不愈合、内固定松动及断裂事件发生。所有患者均获随访,时间8-24个月。骨折愈合时间10-16周,平均12.5周。骨盆骨折复位按照Matta评分标准:优15例,良3例,可2例,差0例,优良率90%。骨盆骨折复位后功能评定按照Majeed评分标准:优13例,良5例,可2例,差0例,优良率90%。提示3D打印技术应用于骨盆骨折可以明确骨折的移位情况,有利于骨折的精确复位及钢板塑性,并且减少了手术操作时间、出血量、并发症以达到更佳修复效果。3D打印技术能够较好的进行骨盆骨折修复前评估及规划,可作为骨盆骨折修复前准备的常规项目。

BACKGROUND： 3D printing technology for preoperative planning has been a trend at present. Moreover, this technology has been extensively used in bone tumor resection and maxillofacial surgery, but seldom used in fracture repair. OBJECTIVE： To explore the value of 3D printing technology application in preoperative evaluation of pelvic fracture, planning and during surgery. METHODS： Pelvic fracture patients underwent preoperative CT scan. Pelvic models of the patients were printed using 3D printing technology at 1：1. Preoperative processing was conducted, including choice of approach, design of incision exposure range, design of fracture reduction, pre-implantation position of the steel plate, optimal plastic design of steel plate, measurement of screw length and design of screw direction. Matta score of pelvic fracture reduction and Majeed score of pelvic function after repair were measured during follow-up. RESULTS AND CONCLUSION： The operation time was 55-130 minutes, averagely（84.75±20.15） minutes. Intraoperative blood loss was 200-800 m L, averagely（417.00±173.58） m L. After operation, no incision infection, fracture nonunion, fixator loosening or breakage appeared. All patients were followed up for 8-24 months. The fracture healing time was 10-16 weeks, averagely 12.5 weeks. Fracture reduction was assessed according toMatta scoring： excellent in 15 cases, good in 3 cases, average in 2 cases, and poor in 0 case, with an excellent and good rate of 90%. Postoperative function was assessed according to Majeed scoring： excellent in 13 cases, good in 5 cases, average in 2 cases, and poor in 0 case, with an excellent and good rate of 90%. These findings showed that the application of 3D printing technology in pelvic fracture can determine the fracture＇s displacement, is helpful for accurate reduction and plate modeling, reduces surgery duration and intraoperative blood loss and complication, finally achieves better surgical result. 3D printing technology can better evaluate and plan the pelvic fracture before repair, and can be used as a routine project preparation of pelvic fracture repair.