摘要
目的探讨基于CT薄层扫描数据的数字化设计和3D打印技术在跟骨关节内骨折手术治疗中的诊疗价值。方法选择2015年1月~2016年3月解放军306医院骨科收治的跟骨关节内骨折患者19例,高处坠落伤15例,摔伤3例,道路交通伤1例,均为新鲜单侧闭合性骨折。男性17例,女性2例;年龄21~56岁,平均38.8岁。Sander's分型:Ⅱ型9例,Ⅲ型10例。采用64排螺旋CT行薄层扫描,Mimics软件处理数据,通过阈值分割、区域增长以及蒙板编辑等完成骨折模型的三维重建,利用3D打印技术制作骨折等比例实体模型;在3D打印实体模型基础上制定手术方案,模拟内固定植入手术,最终将模拟钢板位置、钢板预弯、螺钉方向和长度等参数应用于实际手术。结果基于CT薄层扫描数据制作的3D打印实体模型可直观地真实展示跟骨关节内骨折的形态特点,8例患者均在术前模拟操作中明确钢板植入位置、螺钉方向、螺钉长度并完成钢板预塑形,手术过程顺利,术中采用的固定钢板位置、螺钉数量与螺钉长度均与术前计划一致,术后复查X线片显示跟骨关节内骨折复位固定满意,钢板及螺钉在位良好。结论基于CT薄层扫描数据的3D打印技术可快速制作跟骨关节内骨折实体模型,在此基础上完成手术模拟及手术方案设计,其应用于跟骨关节内骨折手术治疗的临床可行性良好。
Objective To investigate the application of 3D printing and digital technology based on CT thin-layer scanning data in preoperative assessment and planning of internal fixation surgery for intra-articular calcaheal fractures. Methods From Jan. 2015 to Mar. 2016,19 cases with intra-articular calcaneal fractures were selected for the surgery. Among the patients, 17 were males and 2 were females with an average age of 38.8 （ 21-56 ） years. Fifteen cases were injured from high fallingg3 from falls and 1 from road traffic accident. All fractures were unilateral and fresh. According to Sander＇s classification, there were 9 cases of type Ⅱ , and 10 cases of type Ⅲ. The date of thin-slice CT scan was imported into Mimics software as DICOM format. Three-dimensional reconstruction of the fracture model was performed on the CT image segmentation, regional growth and mask editing by Mimics software. 3D printing technology was used to print the fracture models. 3D printing model was used for the operative planning of digital design and the simulation operation was completed. Then the operation was implemented according to the parameters in virtual preoperative design, such as fixation position of the plates, the pre-bending of the steel plate, the direction and length of the screw and other parameters used in the actual operation. Results Based on thin-slice CT scan data,3D printing solid model intuitively showed real form characteristics of the intra-articular calcaneal fractures. The plate location, direction of screw, screw length and the preliminary shaping of plate were determined in the preoperative simulation operation of all 8 cases. After smooth operation, the parameters of orientation,length, diameter, and angle in the operation were all consistent with the preoperative plan. The postoperative X- ray films showed good reduction,satisfactory fixation, and plate and screw in good position. Conclusion 3D printing technology based on thin-slice CT scan data can be used to quickly create a solid model of intra-articular calcaneal fracture for virtual simulation surgery and protocol design of surgery. This technique can be applied for the treatment of intra-articular calcaneal fractures with good clinical feasibility.
出处
《创伤外科杂志》
2017年第6期421-425,共5页
Journal of Traumatic Surgery
关键词
跟骨骨折
3D打印
手术模拟
数字化设计
calcaneal fracture
three-dimensional printing
simulation operation
digital design
