3D打印技术在骶骨骨折治疗中的临床应用

Clinical application of 3D printing technique in treating sacral fracture

目的探讨3D打印技术在骶骨骨折治疗中的作用。方法选择2010年1月~2015年1月陕西省第四人民医院骨科收治的骶骨骨折合并骶神经受损患者19例。Denis分类:Ⅱ型7例,Ⅲ型12例,均合并不同程度的骶神经受损。根据术前CT扫描三维重建,充分了解骨折移位程度及骶神经走行区受压情况,根据三维重建立体结构及术者经验,进行软件预置螺钉,测量内固定的相关指标(直径、长度、角度),进行预手术,观察可能产生的效果,是否需要术者行扩大减压。按照计划进行手术治疗,术后定期拍X线平片、CT扫描三维重建,了解椎弓根螺钉及髂骨钉有无松动、骨折愈合情况;进行Gibbons评分及Mjeed疗效标准评分,评价术后神经功能和临床疗效,进而评价该技术的可行性和有效性。结果所有患者均行3D打印模型辅助下的手术规划、骨折复位、植骨融合内固手术治疗,手术顺利,无切口感染、压疮等并发症出现。均获得1年以上随访。术后X线片或CT显示骶骨骨折均固定稳定,愈合良好。术后所有患者神经功能较术前均有不同程度改善,Gibbons评分由术前(5.21±0.49)分恢复至术后(2.18±0.51)分,差异有统计学意义(P<0.05)。Mjeed疗效达到优良率84.2%。结论术前3D打印技术可充分了解骶骨骨折的损伤程度、骶神经走行区受压情况,进而指导减压范围及置钉节段,术前更加精确的设计手术方案有助于减少手术时间,提高骨折复位及神经减压的准确性,有利于骶神经的恢复,降低内固定失败的发生率,对临床治疗具有一定的指导意义。

Objective To disscuss the effect of 3D printing technique in treating sacral fracture. Methods From January 2010 to January 2015, in Department of Orthopaedics, Shaanxi Fourth People＇s Hospital, 19 patients with sacral fracture accompanied with sacral nerve injury were selected. According to the Denis classification, 7 cases were type Ⅱand 12 cases were type Ⅲ. All patients had varying degrees of sacral nerve damage symptoms. According to the threedimensional reconstruction of CT scan before operation, the degree of fracture displacement and the compression of the sacral nerve were fully understood. According to the three-dimensional reconstruction of the three-dimensional structure and the experience of the operator, the software preposition screw was carried out to measure the relevant indexes（diameter, length and angle） of internal fixation, and to observe the possible effect and whether it was needed, that surgeon expanded the decompression. According to the plan, the surgical treatment was performed. After the operation, the X-ray plain film and CT scan were regularly taken. The pedicle screw and the iliac bone nail had no loosening and the fracture healing. The Gibbons score and the Mjeed curative effect standard score were carried out to evaluate the postoperative nerve function and clinical efficacy, and then the feasibility and effectiveness of the technique were evaluated. Results All patients were treated with the aid of 3D printing model, fracture reduction, bone graft fusion and internal fixation, the operation went well, and there were no incision infection, pressure sore and other complications. And all of them were followed up for more than 1 year. Postoperative X-ray or CT showed that sacral fractures were stable and well healed. The neurological function of all the patients after operation was improved in different degrees. The Gibbons score was recovered from（5.21±0.49） points before operation to（2.18±0.51） points after operation, the difference was statistically significant（P〈0.05）. The effective rate of Mjeed was 84.2%. Conclusion Preoperative 3D printing technology is helpful not only on fully understanding the degree of sacral fracture damage, sacral nerve compression area, but also on supervising decompression range and placement of nail segments. These technologies can help surgeons make accurate preoperative design of surgical procedures plan, decrease operation time, improve fracture reduction and nerve decompression accuracy, which will help the recovery of sacral plexus, reduce the incidence of failure of internal fixation. In a word, these technologies have a certain guiding significance for clinical treatment.