3D打印在肋骨骨折内固定中的应用

The utility of 3D printing for implant design for rib fracture fixation

目的应用3D打印技术在术前重建损伤部位的肋骨骨折形态，指导个体化塑形肋骨内固定钛板，方便进行复杂肋骨骨折的内固定。方法术前应用3DSlicer软件读取3例患者共10根肋骨CT图像数据，并对肋骨进行三维重建，通过对肋骨骨折端进行数字重建，模拟肋骨复位固定，应用桌面型3D打印机在术前打印肋骨模型，根据肋骨模型塑形肋骨内固定钛板用于骨折手术。结果重建模型平均长度8．45cm，重建时间平均18．8min，每个重建模型平均消耗材料4．6g，对重建模型实测与软件测量平均误差小于0．2mm，根据重建模型塑形钛板平均时间为3．3min，术后骨折对位对线良好，随访3个月无内固定物移位脱出。结论桌面型3D打印技术可应用于骨折模型的术前重建，具有成本低，精确度高，易于掌握的特点。可广泛应有于术前人工假体的个性化设计，利于进行复杂手术设计。

Objective 3 D printing has been used in the assistanceof surgical planning and the development of personal- ized prostheses. This study was to determine the feasibility of using a 3D printer for the purpose of producing personalized pros- theses for complex rib fracture fixalion. Methods Using data from a high-resolution CT scan of 10 ribs of 3 cases with rib frac- ture, rib moldswere generated with computer software and fabricated with the 3D printer using the fused deposition modeting method. The 3D printing molds were used for custom-designed titanium plate. Results The average length of the 3D models of ribs is 8.45 cm. The mean time of fabricating models was 18.8 minutes and 4.6 gram polylactic acid was consuming on average. The mean error of dimension of 3D models is less than 0. 2 mm. Reshaping plates spends 3.3 minutes on average. Radio- logical follow-up for bothcases demonstrated successful fixation at 3 months. Conclusion These cases demonstrate the feasibility of the use of 3D modeling and printing to develop personalizedplates and can ease the difficulty of complex rib fracture.