3D打印在陈旧性胫骨平台骨折治疗中的应用

发布时间：2018-03-14 03:11

本文选题：3D打印技术　切入点：胫骨平台骨折　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨利用3D打印技术术前制作骨折模具应用于治疗陈旧性胫骨平台骨折的疗效。方法:选取2009年9月~2016年9月在吉林大学第二医院创伤外科就诊的9位陈旧性胫骨平台骨折患者。男性5名,女性4名,平均年龄39.5岁(34-58岁),受伤机制:高处坠落伤一例,骨髓炎术后2例,摔伤6例。骨折Schatzker分型:Ⅱ型2例、Ⅲ2例、Ⅳ3例、Ⅴ型2例。患者从受伤到截骨植骨内固定的时间平均为5.7个月(2-9个月)。在术前所有患者行患肢膝关节3D CT扫描检查,数据保存为DICOM格式,输入mimics三维建模软件,获得数字化胫骨平台三维模型,将生成的STL文件导入3D打印机中,使用热塑性好的液态光敏树脂在激光照射下层层累积成型,从而获得个体化形态的1:1实物模型。在术前设计时可以进行模拟截骨,设计最佳截骨部位、恢复胫骨平台的高度、挑选合适接骨板及螺钉行模拟固定,并在模拟过程解决所遇到的棘手问题。最大程度恢复胫骨平台下肢力线及局部解剖关系。在术中根据术前计划,对照模具进行截骨及进行一系列操作,截骨后留下较大间隙需植入自体骨或人工骨。结果:3D打印的胫骨平台模型与患者实际情况具有良好的形态一致性,在模型上进行截骨,临时克氏针固定,选择合适接骨板进行塑形及模拟固定,确保恢复胫骨平台解剖结构及下肢力线,手术时按照术前计划找到相应解剖部位截骨,恢复胫骨平台解剖及下肢力线,选择术前选定的接骨板贴附于计划固定位置,C型臂透视,患肢力线纠正,骨块固定稳定。术后随访6周~12个月。患者术后3天在医师指导下开始功能练习,出院后自己或家属辅助练习。于术后6周、3个月、12个月回访。结果如下:膝关节活动度均可伸至0-30°,屈曲在90°-120°;Merchant评分[1],7例评分为优良,2例评分为可。Merchant各项评分结果:活动范围伸至0-30°,屈曲在90°-120°;骨折解剖复位情况:全为优良;全部无行走障碍;两例在运动时偶有疼痛。3D打印的骨科产品是大小及结构特征与患者个性化局部解剖结构特点一致的实物模型,为术者对疑难矫形病例作出更优的术前计划奠定了坚实的物质基础,为虚拟手术设计与现实操作之间架起了一座桥梁。患肢等比例模具能让医师能够更好地了解畸形的特点,便于分析畸形的原因;手术设计因更多人的参与更加周详、优化;术前演练既可使术者在术中操作流畅,也可把术中可能出现的棘手问题提前到术前得到稳妥的解决。这使得术中操作更加熟练、准确度更高,手术时间减少及手术医师和患者的射线暴露减少,最终使得临床疗效得到了明显改善和提高。结论:3D打印技术打印出1:1的个性化定制模型,用于进行术前设计,给医师更加直观的视觉及触觉感受,让医师能更深入的了解病情,使手术设计更加充分、准确;在模型上模拟手术操作过程,熟练操作且预估术中可能遇到的问题,并提出解决方案,使手术过程更加顺利,有效缩短手术时间,提高手术复位固定效果,术后随访明显改善了患者的生活质量;同时模型也为医学教学及术前与患者交流病情提供新的方法,使术前沟通更有效。
[Abstract]:Objective: To explore the use of 3D printing technology used in making mold preoperative fracture curative effect in the treatment of old tibial plateau fracture. Methods: from September 2009 September ~2016 fracture in the treatment of trauma surgery, the second hospital of Jilin University 9 old tibial plateau patients. 5 males and 4 females, the average age of 39.5 years (34-58 years). The mechanism of injury: a case of falling injury, 2 cases of postoperative osteomyelitis, 6 cases of falls. According to the Schatzker classification: 2 cases of type III, IV in 2 cases, in 3 cases, 2 cases of type V. Patients from injury to bone graft bone in average time was 5.7 months (2-9 months) in all patients before surgery for knee 3D CT scan data saved as DICOM format, input mimics three-dimensional modeling software, 3D digital model of tibial plateau, will generate the STL file into the 3D printer, the use of liquid photosensitive resin thermoplastic good in laser irradiated layers The cumulative molding, thereby obtaining the 1:1 physical model of individual form. In the preoperative design can simulate osteotomy, the optimal design of the osteotomy site, restore tibial plateau height, select appropriate plates and bolts for simulation and fixed, solve difficult problems encountered in the simulation process. The maximum degree of recovery of the lower extremity of tibial plateau and the local anatomy. During the operation according to the preoperative plan, control mold osteotomy and a series of operations, after the osteotomy gap left large autogenous bone or artificial bone. Results: the actual situation and the risk model of tibial plateau 3D printing has the form of good consistency, osteotomy on the model, temporary Kirschner wire, select the appropriate plate for shaping and Simulation of fixed, ensure the restoration of tibial anatomy and limb alignment, surgery according to the preoperative plan to find the corresponding anatomic location of osteotomy, recovery Tibial anatomy and limb alignment, preoperative selection plate attached to the selected project fixed position, C arm fluoroscopy, limb force line correction, bone block fixation. Postoperative follow-up of 6 weeks ~12 months. Patients after 3 days under the guidance of doctors began functional exercise after discharge, or their families is the auxiliary practice. After 6 weeks, 3 months, 12 months. The results are as follows: the knee joint can be extended to 0-30 degrees of flexion in 90 DEG -120 DEG [1]; Merchant score, 7 cases were excellent, 2 cases were.Merchant score results: range up to 0-30 in 90 degrees, -120 degrees flexion; anatomical fracture: all good; no walking disorder; two cases in the Department of orthopedics product movement occasional pain.3D printing is the size and structure characteristics of patients with personalized anatomical model consistent with the structural features, operation of difficult cases to better orthopedic disease preoperative The plan has laid a solid foundation, is the bridge between design and actual operation of virtual surgery. The limb proportions of mold can let a doctor to better understand the deformity characteristics, to facilitate analysis of the reasons for surgical deformity; design of more people to participate in more thorough optimization; preoperative exercise can make patients smooth operation in the operation, but also the difficult problems that may arise during the early to get safe preoperative solution. This makes the operation more skilled, more accurate, the operation time and reduce radiation surgery for doctors and patients to reduce exposure, eventually making clinical efficacy has been obviously improved. Conclusion 3D printing technology to print out the customization of the 1:1 model, for the design before operation, give physicians more intuitive visual and tactile feel, so that doctors can more in-depth understanding of the disease, make the operation more accurate design fully. In the operation process; simulation model, and the predicted skilled operation may encounter problems in operation, and proposes the solutions to make the operation more smoothly, effectively shorten the operation time, improve the surgical fixation effect, postoperative follow-up can significantly improve the patient's quality of life; at the same time, the model also provides a new method for medical teaching and preoperative communication with the patient condition, make preoperative communication more effective.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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