3D打印导板技术在脑出血微创穿刺引流术中的应用

Application of 3D printing guide system in minimally invasive puncture and drainage of cerebral hemorrhage surgery

目的探讨通过数字化设计和3D打印技术研制个体化导板指导高血压脑出血微创穿刺引流手术的临床效果。方法选择自2015年10月至2015年12月在滨州医学院附属医院神经外科行微创穿刺手术治疗的8例脑出血患者，通过数字化建模技术获得血肿的三维立体图形，设计1个包含穿刺引导通道的最佳个性化导板，采用3D打印技术进行打印后体外模拟穿刺。术中将导板严密贴合于穿刺部位，沿引导杆按照测量深度穿刺。术后复查CT验证手术效果。结果8例患者均顺利完成术前个体数字化设计及3D打印，并在导板引导下完成血肿穿刺手术操作。术后CT显示8例患者穿刺精准度满意6例，合格1例，差1例。进针方位均与术前设计的虚拟方案一致，无穿刺失败，未出现血管、神经损伤症状。结论采用数字建模技术、3D打印导板技术辅助手术穿刺血肿是治疗高血压脑出血的一项精准、安全、有效的新技术。

Objective To study the design and application of customized navigation module manufactured by digital modeling and 3D-printing technology in the minimal-invasive-puncture surgery for cerebral hemorrhage. Methods Eight patients with cerebral hemorrhage, admitted to our hospital from October 2015 to December 2015 and aged from 33-80 years old （with an average age of 55.7）, including 6 male and 2 female, were chosen as study objects. The 3-dimensional image was obtained by three dimensional reconstruction technique. A perfectly personal navigation module included puncturing-guidance-channel was designed and printed by 3D-printing technology. The printing module was tested in surgery. The module was tightly attached to the puncturing area, and the puncturing was performed following the guide system during the surgery. Post-operation cerebral CT scan was performed to evaluate the surgery effect. Results All the 8 patients successfully received surgery. Post-operation cerebral CT scan showed satisfied results which were classified based on accuracy： 6 enjoyed highly accurate results, one qualified result and one acceptable result. The actual puncture direction was the same with that in the pre-operation mimic process. No puncture failure, blood vessel or nervous injury symptoms were found. Conclusion Pre-operation personal 3D printing navigation is an accurate, safe and effective novel method to treat cerebral hematoma.