3D打印骨水泥塑型器在四肢骨缺损修复中的应用

APPLICATION OF THREE-DIMENSIONAL PRINTING CUSTOMIZED BONE CEMENT MODELS ON REPAIR OF BONE DEFECT OF LIMBS

目的探讨利用3D打印技术制备的骨水泥塑型器在骨水泥填充修复四肢骨缺损手术中的应用价值。方法2015年2月-2016年3月，收治四肢骨缺损患者13例。男9例，女4例；年龄20～58岁，平均38．4岁。慢性骨髓炎7例，骨结核3例，骨肿瘤2例，骨缺血性坏死1例。病变部位：肱骨3例，股骨4例，胫骨6例。骨缺损长度为4．5。8．9cm，平均6．7cm。术前采用Mimics10．01软件设计骨水泥植入物数字模型，3-matic软件设计骨水泥塑型器模块，并3D打印。术中病变骨组织切除后，将骨水泥填充至骨水泥塑型器，制备骨水泥植入物并修复缺损。结果ImageT软件测量示经镜像还原的数字模型与骨接触面匹配指数为95．1％-97．4％，平均96．3％；骨水泥植入物与骨接触面匹配指数为91．2％～94．7％，平均93．2％。骨水泥植入物和塑型器分离过程中未出现骨水泥碎裂及脱落，塑型一次成功。术后切口均I期愈合。患者均获随访，随访时间5—17个月，平均9．4个月。x线片复查示，骨水泥植入物位置良好，无断裂发生；无周围骨折等并发症发生。结论采用3D打印骨水泥塑型器可缩短手术时间，其个性化塑型的骨水泥植入物与周围骨与软组织较匹配，不仅有效避免了术中二次调整，还更加符合术区生物力学传导分布。

Objective To determine the feasibility of fabricating molds using a three-dimensional （3D） printer for producing customized bone cement for repairing bone defect. Methods Between February 2015 and March 2016, 13 patients with bone defects were treated. There were 9 males and 4 females with an average age of 38.4 years （range, 20-58 years）, including 7 cases of chronic osteomyelitis, 3 cases of bone tuberculosis, 2 cases of bone tumor, and 1 case of ischemic necrosis. The defect located at the humerus in 3 cases, at the femur in 4 cases, and at the tibia in 6 cases. The defect ranged from 4.5 to 8.9 cm in length （mean, 6.7 cm）. Before operation, Mimics10.01 software was used to design cement prosthesis, 3-matic software to design shaping module which was printed by 3D technology. After removal of the lesion bone during operation, bone cement was filled into the shaping module to prepare bone cement prosthesis for repairing defect. Results The measurement result from Image J software showed that the match index of interface between the mirror restored digital and bone interface was 95.1%-97.4% （mean, 96.3%）; the match index of interface between bone cement prosthesis and bone interface was 91.2%-94.7% （mean, 93.2%）. It was one time success during separation between formed bone cement and shaping module without any shatter or fall off. All incisions healed by first intention. The cases were followed up 5-17 months （mean, 9.4 months）. X-ray films and CT scans showed good position of bone cement prosthesis without any fracture; no peripheral fracture occurred. Conclusion 3D printing customized bone cement shaping module can shorten the operation time, and customized bone cement prothesis has good match with bone interface, so it can avoid further adjustment and accord with the biomechanical rules of surgical site.