3D打印导板在儿童肱骨髁上骨折治疗中的应用

Application of 3D printed needle guide in the treatment of supracondylar fracture of the humerus in children

目的探讨在儿童髁上骨折治疗中应用3D打印导板辅助置针的可行性及价值。方法2016年9月-2018年12月在我院治疗肱骨髁上骨折的患儿,采用导板辅助置针的方式治疗骨折。术前进行薄层CT扫描,肘关节三维重建,将数据导入Mimics14.0软件中进行骨折图像的预复位,而后设计出克氏针放置的导板,将三维数据模型输入3D打印机,生产出实物导板,手术时将截骨导板与肘部皮肤贴合,由导孔置针固定骨折。结果本组手术时间35-75mim,置针时间4-8min;平均55min,平均置针时间5min,术中失血量2-6ml,平均4ml,复位后穿针摄片次数2-5次,平均3次,20例均获得随访8-12个月,平均10个月。随访中综合屈伸功能评价:优14例,良4例,一般2例。结论导板辅助置针可减少骨折治疗过程中患儿与医生的放射暴露时间,使得置针更加简单,对患儿骨骼损伤更小,提高治疗肱骨髁上骨折的水平。

Objective To investigate the feasibility and value of using 3D printed guides to assist needle placement in the treatment of supracondylar fractures in children. Methods From September 2016 to December 2017, in our hospital, children with humeral supracondylar fractures were treated with guide plates to assist in the treatment of fractures. A thin layer cT scan was performed before operation, and the elbow joint was reconstructed in three dimensions. The data was imported into Mimics 14.0 software for pre-reset of the fracture image. Then the guide plate placed by the Kirschner wire was designed, and the 3D data model was input into the 3D printer to produce the physical guide. During the operation, the osteotomy guide plate is attached to the skin of the elbow, and the fracture is fixed by the guide hole. Results The operation time of this group was 35-75 mim, the needle placement time was 4-8 min;the average time was 55 min, the average needle placement time was 5 min, the intraoperative blood loss was 2-6 ml, the average was 4 ml, and the number of needles after reduction was 2-5 times. Three times, 20 patients were followed up for 8-12 months, with an average of 10 months. The comprehensive flexion and extension function evaluation during follow-up: excellent in 14 cases, good in 4 cases, and general in 2 cases. Conclusion The guide plate assisted needle can reduce the radiation exposure time of the children and doctors during the treatment of the fracture, making the needle simpler, less bone damage to the child, and improving the level of treatment of the supracondylar fracture of the humerus.