3D打印技术在复杂胫骨平台骨折临床诊治中的应用

发布时间：2018-03-31 00:14

本文选题：胫骨骨折　切入点：三维打印　出处：《安徽医科大学》2016年硕士论文

【摘要】：目的胫骨平台骨折是临床上常见得关节内骨折,常为高能量暴力损伤所致,严重者多合并有半月板、韧带的损伤,治疗不当,可造成严重的膝关节功能障碍,治疗上比较棘手。目前,对于复杂胫骨平台骨折临床治疗上主要以切开复位内固定手术(Open Reduction and Internal Fixation ORIF)为主,手术效果满意。本研究旨在观察在复杂胫骨平台骨折临床诊治过程中,应用计算机辅助技术和3D打印技术对胫骨平台骨折诊治的影响。方法选取安徽医科大学第四附属医院骨科2013年6月-2014年1月收治的10例Schatzker V型胫骨平台骨折患者,按随机化原则进行分组,其中5例为对照组(A组),5例为观察组(B组),2组患者均采用膝关节前内外侧手术入路进行切开复位加植骨内固定术,均由同一组医生进行手术。对照组在常规影像学检查后,根据术者经验制定手术方案,进行手术。观察组术前利用CT扫描数据,在Mimic软件进行3D重建,快速成型制备出1：1的模型,以此对骨折进行明确诊断和分型,制定详细的手术方案,术前进行手术预演,选择合适的钢板、螺钉,对钢板进行预处理,然后进行手术。对比2组患者的骨折复位效果、手术时间和术中出血量。结果观察组术中所见与虚拟3D重建图像及3D打印模型基本相似,均为Schatzker V型胫骨平台骨折,2组患者均获得了良好的骨折复位。观察组手术出血量(150±32.15)m1,较对照组的(200±25.30)ml少,差异有统计学意义(p0.05);观察组的平均手术时间为(105±11.85)min,较对照组的(140±20.25)min少,差异有统计学意义(p0.05)。结论应用计算机辅助技术和3D打印技术,可以直观的了解骨折的类型及移位程度,提高手术医生对复杂胫骨平台骨折的认识,制定更加详细的手术方案,术前可在骨折模型上进行模拟骨折复位,并根据模型选择合适大小、类型的钢板,对钢板进行预处理,使之更加伏贴,从而缩短手术时间,减少术中出血量,提高了手术疗效。
[Abstract]:Objective tibial plateau fracture is a common intraarticular fracture in clinic, often caused by high energy violence injury. In severe cases, meniscus and ligament injury are often associated with improper treatment, which can result in serious dysfunction of knee joint. At present, for complex tibial plateau fractures, open Reduction and Internal Fixation ORIFA is the main clinical treatment of complex tibial plateau fractures. The purpose of this study was to observe the clinical diagnosis and treatment of complex tibial plateau fractures. Methods Ten patients with Schatzker V-type tibial plateau fractures treated in Department of Orthopaedics, fourth affiliated Hospital of Anhui Medical University from June 2013 to January 2014 were selected. According to the principle of randomization, 5 cases were divided into two groups: group A (control group), group A (n = 5), group B (n = 5) and group B (n = 5). All the patients were operated by the same group of doctors. The control group made the operation plan according to the experience of the operator after routine imaging examination. The observation group performed 3D reconstruction by using CT scan data before operation and using Mimic software. The 1:1 model was made by rapid prototyping, which was used to diagnose and type the fracture clearly, to make the detailed operation plan, to pre-perform the operation before operation, to select the appropriate plate and screw, and to pretreat the plate. Then the operation was performed. The effect of fracture reduction, the time of operation and the amount of intraoperative bleeding were compared between the two groups. Results the intraoperative findings in the observation group were similar to those in the virtual 3D reconstruction image and the 3D printing model. The operative bleeding volume of the observation group was 150 卤32.15 渭 m ~ (-1), which was less than that of the control group (P < 0.05), and the average operation time of the observation group was 105 卤11.85 minutes, which was less than that of the control group (140 卤20.25)min). Conclusion the application of computer aided technique and 3D printing technology can intuitively understand the fracture type and displacement degree, improve the surgeon's understanding of complex tibial plateau fracture, and make a more detailed operation plan. In order to shorten the operation time, reduce the amount of intraoperative bleeding and improve the curative effect, the plate can be pretreated by selecting the appropriate size and type of steel plate according to the model before operation, so as to shorten the operation time, reduce the amount of intraoperative bleeding and improve the curative effect of the operation.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R687.3

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