本文選題：3D打印技術(shù)　切入點：脛骨平臺骨折　出處：《吉林大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討利用3D打印技術(shù)術(shù)前制作骨折模具應(yīng)用于治療陳舊性脛骨平臺骨折的療效。方法:選取2009年9月~2016年9月在吉林大學(xué)第二醫(yī)院創(chuàng)傷外科就診的9位陳舊性脛骨平臺骨折患者。男性5名,女性4名,平均年齡39.5歲(34-58歲),受傷機制:高處墜落傷一例,骨髓炎術(shù)后2例,摔傷6例。骨折Schatzker分型:Ⅱ型2例、Ⅲ2例、Ⅳ3例、Ⅴ型2例�；颊邚氖軅浇毓侵补莾�(nèi)固定的時間平均為5.7個月(2-9個月)。在術(shù)前所有患者行患肢膝關(guān)節(jié)3D CT掃描檢查,數(shù)據(jù)保存為DICOM格式,輸入mimics三維建模軟件,獲得數(shù)字化脛骨平臺三維模型,將生成的STL文件導(dǎo)入3D打印機中,使用熱塑性好的液態(tài)光敏樹脂在激光照射下層層累積成型,從而獲得個體化形態(tài)的1:1實物模型。在術(shù)前設(shè)計時可以進行模擬截骨,設(shè)計最佳截骨部位、恢復(fù)脛骨平臺的高度、挑選合適接骨板及螺釘行模擬固定,并在模擬過程解決所遇到的棘手問題。最大程度恢復(fù)脛骨平臺下肢力線及局部解剖關(guān)系。在術(shù)中根據(jù)術(shù)前計劃,對照模具進行截骨及進行一系列操作,截骨后留下較大間隙需植入自體骨或人工骨。結(jié)果:3D打印的脛骨平臺模型與患者實際情況具有良好的形態(tài)一致性,在模型上進行截骨,臨時克氏針固定,選擇合適接骨板進行塑形及模擬固定,確�；謴�(fù)脛骨平臺解剖結(jié)構(gòu)及下肢力線,手術(shù)時按照術(shù)前計劃找到相應(yīng)解剖部位截骨,恢復(fù)脛骨平臺解剖及下肢力線,選擇術(shù)前選定的接骨板貼附于計劃固定位置,C型臂透視,患肢力線糾正,骨塊固定穩(wěn)定。術(shù)后隨訪6周~12個月�；颊咝g(shù)后3天在醫(yī)師指導(dǎo)下開始功能練習(xí),出院后自己或家屬輔助練習(xí)。于術(shù)后6周、3個月、12個月回訪。結(jié)果如下:膝關(guān)節(jié)活動度均可伸至0-30°,屈曲在90°-120°;Merchant評分[1],7例評分為優(yōu)良,2例評分為可。Merchant各項評分結(jié)果:活動范圍伸至0-30°,屈曲在90°-120°;骨折解剖復(fù)位情況:全為優(yōu)良;全部無行走障礙;兩例在運動時偶有疼痛。3D打印的骨科產(chǎn)品是大小及結(jié)構(gòu)特征與患者個性化局部解剖結(jié)構(gòu)特點一致的實物模型,為術(shù)者對疑難矯形病例作出更優(yōu)的術(shù)前計劃奠定了堅實的物質(zhì)基礎(chǔ),為虛擬手術(shù)設(shè)計與現(xiàn)實操作之間架起了一座橋梁�；贾缺壤＞吣茏屷t(yī)師能夠更好地了解畸形的特點,便于分析畸形的原因;手術(shù)設(shè)計因更多人的參與更加周詳、優(yōu)化;術(shù)前演練既可使術(shù)者在術(shù)中操作流暢,也可把術(shù)中可能出現(xiàn)的棘手問題提前到術(shù)前得到穩(wěn)妥的解決。這使得術(shù)中操作更加熟練、準確度更高,手術(shù)時間減少及手術(shù)醫(yī)師和患者的射線暴露減少,最終使得臨床療效得到了明顯改善和提高。結(jié)論:3D打印技術(shù)打印出1:1的個性化定制模型,用于進行術(shù)前設(shè)計,給醫(yī)師更加直觀的視覺及觸覺感受,讓醫(yī)師能更深入的了解病情,使手術(shù)設(shè)計更加充分、準確;在模型上模擬手術(shù)操作過程,熟練操作且預(yù)估術(shù)中可能遇到的問題,并提出解決方案,使手術(shù)過程更加順利,有效縮短手術(shù)時間,提高手術(shù)復(fù)位固定效果,術(shù)后隨訪明顯改善了患者的生活質(zhì)量;同時模型也為醫(yī)學(xué)教學(xué)及術(shù)前與患者交流病情提供新的方法,使術(shù)前溝通更有效。
[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.

【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3

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