肋软骨多层螺旋CT容积重建和3D打印技术在耳廓再造术中的应用

Application of multislice computed tomography volume rendering and 3D printing technique of costal cartilage for auricular reconstruction

目的 探讨多层螺旋CT容积重建（volume rendering,VR）技术和3D打印技术在耳廓再造术中的辅助作用.方法 选取6例自体肋软骨耳廓再造患者,其中先天性小耳畸形5例,外伤后耳廓缺失1例.对患者肋软骨行VR操作,获取患耳对侧第6-9肋软骨的三维数据,制定、评价肋软骨取材和耳廓支架雕刻方案.将重建数据以STL文件形式导出,用无毒的尼龙材料打印成三维实体模型,并进行手术模拟,对方案进行评估,根据最终方案实施耳廓再造术.结果 6例患者术中肋软骨取材和耳廓支架雕刻方案均与术前设计和模拟结果一致,肋软骨取材合理.术后再造耳廓形态良好,无感染、吸收、变形等并发症,无明显胸廓畸形发生.结论 软骨VR和3D打印技术可使术前设计更加合理,并进行有效的术前模拟,改善手术效果,减少手术创伤,降低胸廓畸形发生的风险.

Objective To investigate the value of Multislice computed tomography volume rendering（VR） technique and 3D printing technique in auricular reconstruction.Methods Six patients were enrolled for auricular reconstruction with costal cartilage,including 5 congenital microtia patients and 1 traumatic auricular defect patient.We harvest the three-dimensional reconstructive data of the contralateral sixth,seventh,eighth and ninth costal cartilage with VR technique.Three-dimensional solid models were 3D printed with nylon material according to the data exported in STL format.Preoperativesimulation was performed on the models,accordingly,we determined the strategies of costal cartilage harvest and framework fabrication,and operations were performed based on the pre-designed plan.Results In all 6 patients,the actual costal cartilage harvest and framework fabrication process was consistent with the preoperative design and simulation results,and more scientific than before.The shapes of reconstructed ears were vivid and natural.No complications such as infection,absorption,distortion and chest deformity happened.Conclusions Through costal cartilage VR and 3D printing technique,we could make more reasonable preoperative design and simulation.The results can be improved with reduced injury,while avoiding the risks of thoracic deformity.