3D打印技术在成人距骨骨折手术中的临床应用

Clinical application of three-dimensional printing technique in surgical treatment of adult talus fractures

目的探讨3D打印技术在成人新鲜距骨骨折手术中初步的应用,评价3D打印技术在成人距骨骨折手术中的指导意义。方法收集2016年1月至2017年10月蚌埠医学院第一附属医院骨科的8例成人新鲜距骨骨折病人(受伤时间3周内),其中6例为单纯距骨骨折。2例病人合并踝关节骨折。8例病人住院期间均进行了"距骨骨折切开复位内固定术"。术前将踝关节行64排螺旋CT扫描,将所获DICOM格式进行三维扫描生成STL格式数据,将STL数据传至3D打印机进行1∶1模型打印,利用模型进行术前病患沟通,选择合适的手术入路及内固定方式,在模型上预操作,术中按照之前制定计划进行"切开复位内固定术",术后踝关节正侧位片检查,术后功能评估按照美国矫形外科足踝协会(AOFAS)评分评价标准,疼痛改善采用视觉模拟评分(visual analogue scale,VAS)评价。数据利用SPSS 22.0软件进行统计学分析。结果优5例,良2例,可1例,优良率为87.5%。结论建立3D打印1∶1模型,选择合适的手术入路及内固定方式,拟定出详细的手术方案及术中可能出现困难的对策,可以达到手术的精准化、微创化及个体化。

Objective To explore the application of three dimensional printing(3DP)technique in the surgical treatment of adult talus fractures,and to evaluate its guiding significance.Methods Eight cases of adult talus fractures(injury time within 3 weeks)who were treated in the Department of Orthopaedics,The First Affiliated Hospital of Bengbu Medical College from January 2016 to October 2017 were collected.There were 6 cases of simple talus fractures and 2 cases of talus fractures combined with ankle fracture.Eight patients were treated with“open reduction and internal fixation for talus fractures”during hospitalization.Before surgery,64-slice spiral CT scanning was performed for all patients.The obtained DICOM format data were reconstructed into STL format data through three dimension scanning,and the STL data were transmitted to the 3D printer for 1∶1 model printing.3D models were used to make communications with patients before operation.Suitable operative approaches and internal fixators were selected to carry out preoperation on models,using“open reduction and internal fixation”according to the previous plan during operation.Positive and lateral X-ray of ankle was performed after operation,and ankle function and pain improvement was evaluated with AOFAS(AOFAS Ankle Hindfoot Scale)and VAS(Visual Analogue Scale),respectively.SPSS 22.0 was used for statistical analysis.Results The results were excellent in 5 cases,good in 2 cases and ordinary in 1 case,and the excellent and good rate was 87.5%.Conclusion Setting up 1∶1 model of 3D printing,selecting suitable operative approaches and internal fixator,drawing up detailed operation plan and strategies to tackle difficulties in operation can achieve accuracy,minitrauma and individualization in operation.