本文選題：脛骨骨折　切入點(diǎn)：三維打印　出處：《安徽醫(yī)科大學(xué)》2016年碩士論文

【摘要】：目的脛骨平臺(tái)骨折是臨床上常見得關(guān)節(jié)內(nèi)骨折,常為高能量暴力損傷所致,嚴(yán)重者多合并有半月板、韌帶的損傷,治療不當(dāng),可造成嚴(yán)重的膝關(guān)節(jié)功能障礙,治療上比較棘手。目前,對(duì)于復(fù)雜脛骨平臺(tái)骨折臨床治療上主要以切開復(fù)位內(nèi)固定手術(shù)(Open Reduction and Internal Fixation ORIF)為主,手術(shù)效果滿意。本研究旨在觀察在復(fù)雜脛骨平臺(tái)骨折臨床診治過(guò)程中,應(yīng)用計(jì)算機(jī)輔助技術(shù)和3D打印技術(shù)對(duì)脛骨平臺(tái)骨折診治的影響。方法選取安徽醫(yī)科大學(xué)第四附屬醫(yī)院骨科2013年6月-2014年1月收治的10例Schatzker V型脛骨平臺(tái)骨折患者,按隨機(jī)化原則進(jìn)行分組,其中5例為對(duì)照組(A組),5例為觀察組(B組),2組患者均采用膝關(guān)節(jié)前內(nèi)外側(cè)手術(shù)入路進(jìn)行切開復(fù)位加植骨內(nèi)固定術(shù),均由同一組醫(yī)生進(jìn)行手術(shù)。對(duì)照組在常規(guī)影像學(xué)檢查后,根據(jù)術(shù)者經(jīng)驗(yàn)制定手術(shù)方案,進(jìn)行手術(shù)。觀察組術(shù)前利用CT掃描數(shù)據(jù),在Mimic軟件進(jìn)行3D重建,快速成型制備出1：1的模型,以此對(duì)骨折進(jìn)行明確診斷和分型,制定詳細(xì)的手術(shù)方案,術(shù)前進(jìn)行手術(shù)預(yù)演,選擇合適的鋼板、螺釘,對(duì)鋼板進(jìn)行預(yù)處理,然后進(jìn)行手術(shù)。對(duì)比2組患者的骨折復(fù)位效果、手術(shù)時(shí)間和術(shù)中出血量。結(jié)果觀察組術(shù)中所見與虛擬3D重建圖像及3D打印模型基本相似,均為Schatzker V型脛骨平臺(tái)骨折,2組患者均獲得了良好的骨折復(fù)位。觀察組手術(shù)出血量(150±32.15)m1,較對(duì)照組的(200±25.30)ml少,差異有統(tǒng)計(jì)學(xué)意義(p0.05);觀察組的平均手術(shù)時(shí)間為(105±11.85)min,較對(duì)照組的(140±20.25)min少,差異有統(tǒng)計(jì)學(xué)意義(p0.05)。結(jié)論應(yīng)用計(jì)算機(jī)輔助技術(shù)和3D打印技術(shù),可以直觀的了解骨折的類型及移位程度,提高手術(shù)醫(yī)生對(duì)復(fù)雜脛骨平臺(tái)骨折的認(rèn)識(shí),制定更加詳細(xì)的手術(shù)方案,術(shù)前可在骨折模型上進(jìn)行模擬骨折復(fù)位,并根據(jù)模型選擇合適大小、類型的鋼板,對(duì)鋼板進(jìn)行預(yù)處理,使之更加伏貼,從而縮短手術(shù)時(shí)間,減少術(shù)中出血量,提高了手術(shù)療效。
[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 鹵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 鹵11.85 minutes, which was less than that of the control group (140 鹵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.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R687.3

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