3D打印钛板塑形模板在髋臼骨折的可行性研究

Feasibility Study of Application of the 3D Printed Template for Titanium Plate before Acetabular Fracture Surgery

目的:设计3D打印髋臼骨折钛板塑形模板并初步应用,了解3D打印钛板塑形模板在髋臼骨折的可行性。方法:回顾2014年1月—2016年7月医院8例进行常规髋臼骨折手术患者的10块钛板,通过建立骨盆与钛板数字模型,测量钛板与髋臼骨面间平均间隙与最大间隙,以其平均值并作为技术标准。纳入2016年7月—2017年12月同意使用3D打印塑形模板辅助的髋臼骨折手术患者3例,共植入钛板6块。术前利用患者CT图像建立骨盆骨折数字模型,设计并3D打印得到钛板塑形模板,在术前比对模板完成钛板塑形,术中骨折复位后安装塑形好的钛板,术后复查CT重建骨盆钛板数字模型,测量"钛板与骨面的平均间隙""钛板与骨面最大间隙",与回顾标准比较。结果:3例患者使用的所有6块钛板术后测量"钛板与骨面平均间隙""钛板与骨面间隙最大值"均小于测量得到的标准。且两组钛板比较"钛板与骨面平均间隙""钛板与骨面最大间隙值"差异具有统计学意义(P<0.05)。结论:在现有技术条件下,使用3D打印钛板塑形模板在术前对髋臼钛板塑形具备可行性。

Objective: To design and apply the 3D printed templet for titanium plate used in acetabular fracture surgery, and explore the feasibility. Methods: From January 2014 to July 2016, 8 patients with acetabular fractures, which had operated in hospital and fixed with 10 titanium plates, were reviewed. The digital models of pelvis and plate were reconstructed from the postoperative CT images.The gap between the titanium plate and surface of acetabular was measured by model distance comparison, and the indicators,"the maximum gap size" and "the average gap size", were harvested. The average of these two indicators were calculated and regarded as a technical standard for further comparison. From July 2016 to July 2017, 3 patients with acetabular fractures implanted 6 titanium plates were included in this study. The digital model of damaged pelvis was reconstructed from the CT images of those wounded patients, and repaired by digital technique. The digital model of template for titanium plate was derived from the surface of the repaired pelvis. It was exported to a stereo lithography apparatus 3D printer and formed by 3D printing. Before operation the titanium plates were modified by comparison with the template, and implanted without other modifications in the operation. Then all patients underwent CT scan again."The maximum gap size" and "the average gap size" of these three patients were measured by the same technique,and compared with the standard. Results:"The average gap size" and "the maximum gap size" between six titanium plates, implanted in 3 patients adopted templet before surgery, and bone surface are all less than the standard. And the differences of "the average gap size" and "the maximum gap size" between two samples of plates are significant(P <0.05). Conclusion: By the existent digital technique, nowadays, it is feasible to design and adopt 3D printed templet to modify the titanium plate before acetabular fracture operation.