3D打印技术在骨科手术辅助中的应用研究

发布时间：2018-08-11 13:15

【摘要】：3D打印技术称为增材制造技术或快速成型技术,是一种对零件形状的复杂程度没有限制、能够快速制造出三维实体模型的先进制造技术。医学和3D打印技术的结合,为定制化、精准化治疗提供了有力的技术支持,尤其在骨科中得到了越来越多的关注及应用研究。3D打印在骨科中的应用主要集中在术前诊断及策划、辅助器械的制作、骨植入物的制备、骨组织工程等方面。故本文对3D打印技术在骨科治疗中的辅助应用进行了研究,为精准化、定制化程度治疗提供了有力的支持。研究了数字骨科模型的建立方法,利用患者的CT扫描数据,在医学图像处理软件中对骨骼进行处理,重建患处的骨骼三维模型。利用正、逆混合建模方法对骨科植入物模型进行数字化建模,获得了骨科植入物的三维CAD模型,建立了数字模型数据库,为术前模拟、3D打印提供了数字模型。针对髋骨骨折、踝关节畸形等9个病例,利用患处的CT扫描数据,通过逆向建模,制备了1:1的病变部位的3D打印模型,用于术前模拟,效果良好。针对1例肱骨头缺损患者,通过提取患者健侧的肱骨头数据,利用镜像方式建立了患侧缺损部位的替代模型,并以此设计并打印了骨水泥的定制化塑型模具,制备了丙烯酸骨水泥替代物,手术效果良好。针对1例喙突骨骨折设计了手术导板。针对1例食指与中指屈肌腱修复手术后的康复要求,研究了个性化康复固定支具的设计与制备方法。以患者前臂的CT扫描数据为基础,并结合手功能位置以及康复锻炼要求,通过正向与逆向结合的方式,设计并3D打印了个性化康复固定支具的模型,并对其力学性能、形状精度等进行了分析。结果表明,该支具的力学性能优于石膏绷带的力学强度,而且形状精度满足要求,具有透气性好、贴合性好、美观、轻便等特点。利用3D打印制作患者的胫骨横断骨折的实物模型,通过三维数字散斑应变测量系统对胫骨—单臂外固定系统进行了压缩实验,与相结合的数值模拟计算方法分析了系统的受力情况以及应力、应变的分布特点,提供了更优的手术方案。
[Abstract]:3D printing technology is called material augmentation manufacturing technology or rapid prototyping technology. It is an advanced manufacturing technology which has no limitation on the complexity of the shape of parts and can quickly produce 3D solid models. The combination of medical technology and 3D printing technology provides powerful technical support for customization and precision treatment, especially in orthopedics, where more and more attention has been paid to the application of .3D printing in orthopedics. The application of 3D printing in orthopedics is mainly focused on preoperative diagnosis and planning. Fabrication of auxiliary instruments, preparation of bone implants, bone tissue engineering and so on. In this paper, the application of 3D printing technology in orthopedic treatment is studied, which provides a powerful support for the precision and customization of the treatment. The method of establishing digital orthopedic model was studied. The bone was processed in medical image processing software with CT scan data of patients and the three-dimensional model of affected bone was reconstructed. The orthopedic implant model was digitally modeled by the method of forward and inverse hybrid modeling. The 3D CAD model of orthopedic implants was obtained, and the digital model database was established, which provided a digital model for pre-operation analogue 3D printing. According to 9 cases of hip fracture and ankle malformation, the 3D printing model of 1:1 lesion was prepared by using CT scan data of affected area, and the result was good. Based on the data of humerus head of a patient with head defect of humerus head, the substitute model of the site of the defect was established by using mirror image, and the customized moulds of bone cement were designed and printed. Acrylic cement substitute was prepared and the effect of operation was good. A surgical guide plate was designed for a coracoid bone fracture. According to the rehabilitation requirements of a case of flexor tendon repair of index finger and middle finger, the design and preparation of individualized rehabilitation fixator were studied. Based on the CT scan data of the patient's forearm, combined with the functional position of the hand and the requirements of rehabilitation exercise, the model of the individualized rehabilitation fixator was designed and 3D printed by combining the forward and reverse ways, and the mechanical properties of the model were analyzed. The shape accuracy is analyzed. The results show that the mechanical properties of the brace are better than that of the gypsum bandage, and the shape precision meets the requirements, and it has the characteristics of good air permeability, good fit, beauty and portability. The physical model of tibial transverse fracture was made by 3D printing, and the compression experiment of tibial-one-arm external fixation system was carried out by means of three-dimensional digital speckle strain measurement system. Combined with the numerical simulation method, the stress, stress and strain distribution of the system are analyzed, and a better operation scheme is provided.
【学位授予单位】：新疆大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3;TP391.73

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