基于CT薄层扫描数据的3D打印技术辅助治疗桡骨远端关节内骨折

Adjuvant Treatment of Intra-Articular Distal Radius Fractures with 3D Printing Based on CT Scan

目的探讨基于CT薄层扫描数据的3D打印技术辅助治疗桡骨远端关节内骨折的临床价值。方法选取2013年4月至2016年9月纳入本研究的41例桡骨远端关节内骨折患者,均接受3D打印技术辅助的精确复位内固定术。其中AO/ASIF分类B型3例,C型38例。将术前CT薄层扫描数据导入3D打印机,快速定制模型以分析具体骨折情况,同时进行模拟的复位内固定手术,制定详细的手术计划,并严格按计划实施手术。记录患者实际使用的接骨板规格和螺钉长度、手术时间、术中出血量和术后随访骨折愈合时间,并评估患者术后复位效果(改良sarmiento系统)和腕关节功能(Dienst标准)。结果 41例患者的手术时间为(49±17) min,术中出血量为(39±21)mL,实际手术时采用的接骨板规格与模拟手术时全部相同,螺钉长度的准确率达98.5%(40例)。患者骨折全部愈合,愈合时间为(8.7±1.1)周。骨折复位优良率为92.7%(38例),桡骨高度为(10.6±2.6) mm,掌倾角为(11.3±3.4)°,尺偏角(21.2±5.4)°。腕关节功能优良率达95.1%(39例)。结论借助3D打印技术可快速定制骨折模型,术者可以进一步直观、形象地分析桡骨远端关节面的骨折情况。通过计算机数字化模拟手术,按定制的手术方案实施精准手术,能提高实际手术的效率和治疗效果。

Objective To evaluate the clinical value of 3D printing based on CT scan in the adjuvant treatment of intra-articular distal radius fractures. Methods From April 2013 to September 2016,41 patients with intra-articular distal radius fractures(3 patients with AO/ASIF type B fractures and 38 patients with AO/ASIF type C fractures) underwent open reduction and internal fixation assisted by CT scan-based 3D printing.According to CT scan data,the models of fractures used for classification were produced by 3D printer.The virtual surgery was carried out with computer.The real surgical procedures were performed accurately according to the pre-operative planning.Bone plate type,screw length,operation time,intraoperative blood loss and healing time were recorded,and postoperative reduction effect(improved Sarmiento system) and wrist function(Dienst criterion) were evaluated in all patients. Results The operation time and intraoperative blood loss were(49±17) minutes and(39±21)mL,respectively.The type of bone plate used in actual operation was same as that used in simulated surgery.The accuracy of screw length reached 98.5%(40 cases).All fractures healed after(8.7±1.1) weeks.The excellent and good rate was 92.7%(38 cases) for fracture reduction,and 95.1%(39 cases) for wrist function.The radial height,palmar tilt and ulnar inclination were(0.6±2.6)mm,(11.3±3.4)° and(21.2±5.4)°,respectively. Conclusion The 3D printing technology can rapidly create fracture model,which can help surgeons have a direct visualization of intra-articular distal radius fractures.In addition,virtual surgery provides patient-specific preoperative planning for accurate surgery,which improves the efficiency and therapeutic efficacy of actual operation.