3D打印个性化经皮髋关节穿刺导向器的初步应用

Preliminary application of 3D printing to manufacture a customized guide plate for clinical per- cutaneous needling at the hip joint

目的探讨3D打印技术制作的个性化髋关节经皮穿刺导向器应用于临床穿刺的安全性与有效性。方法2015年4月至8月期间共收治9例需要进行髋关节穿刺的患者，男7例，女2例；年龄为21-53岁，平均42岁；左侧5例，右侧4例。疾病类型：创伤性关节炎4例，骨性关节炎5例。对其髋关节进行薄层CT扫描，选取扫描数据导入Mimies10．01软件进行三维重建，应用3-mmic软件对重建的模型进行个性化设计，利用3D打印技术制作导向器。穿刺前对进针的角度、方向及深度进行体外校正，模拟术中过程。分别对9例患者进行髋关节穿刺，术后在C型臂X线机透视下对穿刺的准确性进行验证。结果术前在患者骨骼模型上模拟的穿刺结果与设计一致，9例患者均穿刺成功。本组9例患者的手术时间平均为417．7s（387—590S），术中穿刺部位有极少量出血。所有患者仅在穿刺验证时进行1次透视。术后患者未出现血管、神经损伤等与手术操作相关的并发症。结论对于反复穿刺的患者，利用3D打印个性化经皮髋关节穿刺导向器可以提高穿刺的准确性，确保穿刺安全、有效。

Objective To investigate the safety and efficacy of a customized guide plate which is designed by digital medical technology and manufactured by 3D printing in clinical percutaneous needling at the hip joint. Methods Enrolled in this study were 9 patients with hip disorder who required hip joint needling during the period from April 2015 to August 2015. They were 7 males and 2 females, 21 to 53 years of age （average, 42 years）. Laterality： 5 left sides and 4 right sides. Conditions： 4 cases of traumatic arthritis and 5 cases of osteoarthritis. All of them underwent lamellar CT scans whose data were imported into the software of Mimics 10. 01 for 3D reconstruction. Then the software of 3-matic was used to design a customized guide plate on the reconstructed models. Finally, 3D printing was used to manufacture the guide plate. The needle angle, direction and depth were adjusted in vitro and the operation was simulated before actual needling in clinic. After percutaneous hip joint needling was performed in the 9 patients separately, the accuracy of needling was checked using C-arm fluoroscopy. Results The percutaneous hip joint needling was per- formed successfully in the 9 patients in whom the customized guide plate was used. The results were consistent with what had been designed on the reconstructed models. The operation time in the 9 patients averaged 417. 7 s （range, from 387 s to 590 g）. Little intraoperative bleeding was observed at the site of needling, fluoroscopy was applied only once for check. No neurovascular injury or other operation-related complications occurred. Conclusion For patients who need repeated percutaneous needling at the hip joint, the customized guide plate designed by us can improve accuracy and ensure safety and efficacy of needling.