摘要
目的通过尸体标本操作,探讨3D打印定位导板辅助MIPO技术在肱骨中上段骨折治疗中的可行性。方法采用新鲜冷冻的成人上肢尸体标本共6例,第1次薄层CT扫描后进行肱骨全长的3D打印,以该模型为参照选取10孔或12孔的长型PHILOS接骨板并螺旋塑形临时固定其上,对肱骨模型和接骨板进行第2次薄层CT扫描,分别参照近端和远端的接骨板外形和相邻的不规则骨面,应用3D打印技术制作相应的定位导板。在尸体标本上截骨建立肱骨中上段骨折的模型,首先在两端分别置入上述3D打印的定位导板,然后采用MIPO技术置入预螺旋塑形的接骨板,通过与两端的定位导板紧密贴合完成间接复位并固定。手术完成后标本摄正侧位X线片和第3次CT扫描,测量骨折断端的移位、成角及旋转角度并与术前相比较,同时标本解剖作大体观察。结果3D打印定位导板与远近端骨面贴合良好,仅2例在大结节弧形表面发生轻度移位,但对骨折断端的大体复位影响不大。定位导板与螺旋预塑形接骨板整合辅助复位后,骨折断端横向移位为(6.05±1.13)mm,X线片上正位成角为(8.90±2.10)°,侧位成角(7.27±1.91)°,内外向旋转绝对值为(7.90±1.90)°。结论3D打印定位导板的辅助应用,有助于MIPO技术在肱骨中上段骨折治疗中的闭合复位,进一步研究可望提高临床疗效。
Objective To identify the feasibility of 3 D-printed template guiding technique on the treatment of the proximal humeral meta-diaphyseal fracture combined with MIPO technique. Methods A total of 6 fresh frozen cadaver samples of adult upper extremity were used. The first thin-slice CT scans was performed to make 3 D-printed model of the full length of the humerus, which was used as a reference to pre-contour the long PHILOS plate. Then the plate was fixed temporarily on the 3 D printing model. The second thin-slice CT scans of the humerus model and the plate was performed, and the corresponding 3 D-printed templates were produced based on the configuration of the proximal and distal plate and the adjacent irregular bone surface. After the proximal meta-diaphyseal fracture was established on the cadaver of the humerus,the 3 D-printed templates were fixed at the corresponding position on the both ends of the humerus, and then the pre-contoured plate was placed by MIPO technique. The templates were tightly attached to both of the plate and in the end of the bone, which resulted in guiding the segments to be reduced after the screw fixation. Finally, the X-ray and the third CT scans were taken to measure the displacement and alignment at the fracture site. Results 3 D-printed templates were just fixed on the corresponding location almostly, except 2 cases with slightly displaced on the spherical surface of the great tubercle. All the fractures were reduced satisfactorily, resulted in laterally displacement of(6.05±1.13) mm, malalignment of(8.90±2.10) °in AP view and(7.27±1.91) °in lateral view, and rotation of(7.90±1.90) °, respectively. Conclusion In the cadaver study, 3 D-printed templates guiding plating by MIPO technology could be used with satisfied reduction on the treatment of the proximal humeral meta-diaphyseal fracture. Moreover, further research might be anticipated to improve the clinical outcome.
作者
黄默冉
刘可心
陈云丰
王磊
Huang Moran;Liu Kexin;Chen Yunfeng;Wang Lei(Department of Orthopedics,Shanghai Sixth People's Hospital,Shanghai,200233,China)
出处
《生物骨科材料与临床研究》
CAS
2020年第1期19-21,共3页
Orthopaedic Biomechanics Materials and Clinical Study
基金
上海交通大学医工交叉面上项目（YG2016MS18)
关键词
3D打印
导板
MIPO
肱骨骨折
3D-printing
Template
Minimally invasive plate osteosynthesis
Humeral fracture
