数字化结合3D打印技术辅助复杂骨盆骨折的手术设计

Operative strategy for complicated pelvic fractures with digital design and three-dimensional printing technique

目的探讨Mimics14.11软件数字化结合3D打印模型模拟手术辅助复杂骨盆骨折内固定的手术设计。方法筛选1例复杂骨盆骨折患者,将患者的骨盆及全套内固定物的薄层CT数据导入Mimics 14.11软件,进行骨折三维建模、骨折块虚拟复位、建立骨盆内固定物标准件库、选取最佳匹配的钢板及螺钉。3D打印出患者1:1的骨盆实体模型,在模型上按照数字化设计进行模拟手术,将骨盆重建板的位置、钉道长度和方向同数字化设计比较,确定术中使用的钢板及螺钉。最后,按照术前演练进行实际手术骨折复位、钢板内固定。结果模拟手术共植入2块重建钢板和15枚螺钉,钢板植入的位置、螺钉植入的方向均与数字化术前设计高度一致,钉道长度与数字化术前设计比较无显著性差异(P>0.05)。实际手术与模拟手术的手术效果一致。结论数字化设计结合3D打印技术实现了复杂型骨盆骨折的个体化、精准化治疗,明显减少了患者的出血量,缩短了患者的康复周期。

Objective To explore the operative strategy of internal fixations for complicated pelvic fractures using Mimics14.11 digital software combining with three-dimensional （3D） printing technique. Methods Thin slice CT scan data of one case of complicated pelvic fractures and the data of all the pelvic internal fixations were imported into Mimics14.11 software to construct 3D models, performed virtual fractures reductions, established standard parts library of pelvis internal fixations, and chosen the most appropriate plates and screws.The 1：1 3D pelvic model was printed to simulate the surgery based on the digital design. Comparisons were made on the plate positions, screw passage lengths and screw directions to determine the final internal fixations. Finally, the fractures reductions and internal fixations were performed in the reality surgery. Results In the simulated surgery, 2 reconstruction plates and 15 screws were implanted, the plate positions and the screw directions were in high accordance with those measured in Mimics 14.11 software. The comparisons between simulated surgery and digital design on screw length had no significant difference （P〉0.05）. The effectiveness of reality surgery was also consist with the simulated surgery. Conclusion By using digital design software and three-dimensional （3D） printing technique, we can realize the individual operation and precise treatment which can achieve less blood loss and shorter hospital stay.