金屬3D打印個(gè)性化髖臼翼狀接骨板的研發(fā)及實(shí)驗(yàn)研究
發(fā)布時(shí)間：2018-12-14 00:01
【摘要】：研究背景骨盆、髖臼解剖結(jié)構(gòu)復(fù)雜,對(duì)于累及四邊體的復(fù)雜髖臼骨折,傳統(tǒng)手術(shù)入路及內(nèi)固定難以滿足復(fù)位、固定要求,采用個(gè)性化接骨板治療復(fù)雜髖臼骨折尚處于空白。研究目的針對(duì)復(fù)雜髖臼骨折患者設(shè)計(jì)個(gè)性化髖臼翼狀接骨板,使用金屬3D打印技術(shù)(SLM)制造,對(duì)該設(shè)計(jì)方法和制造方式進(jìn)行可行性及安全性驗(yàn)證,經(jīng)驗(yàn)證成功后將其應(yīng)用于臨床,對(duì)患者進(jìn)行隨訪研究,評(píng)價(jià)其優(yōu)勢(shì)及早期臨床治療療效。研究方法對(duì)某一復(fù)雜髖臼骨折患者骨盆數(shù)字化三維重建,對(duì)骨折進(jìn)行模擬復(fù)位、置釘,利用鏡像原理及逆向工程技術(shù),設(shè)計(jì)完全解剖型的個(gè)性化翼狀接骨板,并進(jìn)行個(gè)性化精準(zhǔn)置釘設(shè)計(jì),采用金屬3D打印技術(shù)制造,對(duì)其進(jìn)行后加工處理,得到產(chǎn)品。對(duì)5具尸體標(biāo)本采用上述方法設(shè)計(jì)并制造10塊個(gè)性化接骨板,采用單一腹直肌外側(cè)入路將其植入到標(biāo)本中,驗(yàn)證使用該入路植入接骨板的可行性,測(cè)量接骨板與貼合骨面的距離,驗(yàn)證其貼合性;對(duì)12名復(fù)雜髖臼骨折患者采用上述方法設(shè)計(jì)并制造12塊個(gè)性化接骨板,將其植入到3D打印骨盆模型中,驗(yàn)證螺釘孔設(shè)計(jì)的安全性�；仡櫺苑治�2016年3月～2016年7月,采用經(jīng)腹直肌外側(cè)入路顯露、復(fù)位,使用3D打印技術(shù)輔助模擬復(fù)位,結(jié)合個(gè)性化設(shè)計(jì)、金屬3D打印髖臼翼形接骨板固定治療8例復(fù)雜髖臼骨折的臨床資料:其中男性4例,女性4例;年齡31-76歲,平均57歲:髖臼骨折按Letournel-Judet分型:前方伴后半橫2例,雙柱骨折6例,均無涉及髖臼后壁骨折及對(duì)側(cè)半骨盆骨折。手術(shù)在插管全麻下平臥位進(jìn)行,經(jīng)前方腹直肌外側(cè)切口入路,直視下對(duì)髖臼前、后柱骨折進(jìn)行復(fù)位,將個(gè)性化設(shè)計(jì)定制的鋼板放置于髖臼的內(nèi)側(cè)面,檢查鋼板與骨面的貼合程度,再按術(shù)前設(shè)定的螺釘位置、方向、長度置入螺釘,C形臂X光機(jī)透視后,檢查骨折復(fù)位、固定情況。結(jié)果采用上述方法成功設(shè)計(jì)并制造出個(gè)性化髖臼翼狀接骨板,接骨板與尸體標(biāo)本骨面平均距離在1mm左右,與3D打印骨盆模型表面平均距離在0.7mm左右,接骨板上所有螺釘均未穿入髖臼窩。本組8例均順利完成手術(shù)。術(shù)后X線及CT顯示髖臼前后柱骨折復(fù)位固定良好,個(gè)性化翼狀接骨板與骨面完全貼合,無圍手術(shù)期并發(fā)癥發(fā)生,按照Matta影像學(xué)復(fù)位評(píng)估標(biāo)準(zhǔn):優(yōu)3例,良4例,一般1例,總體優(yōu)良率87.5%;隨訪9～12個(gè)月,骨折均愈合;根據(jù)改良的Merled' Aubigne和Postel評(píng)分系統(tǒng),髖關(guān)節(jié)功能:優(yōu)5例,良2例,可1例,總優(yōu)良率87.5%。結(jié)論應(yīng)用鏡像原理和逆向工程原理設(shè)計(jì)的個(gè)性化接骨板貼合度高,螺孔設(shè)計(jì)安全有效;經(jīng)腹直肌外側(cè)切口入路結(jié)合個(gè)性化設(shè)計(jì)、私人定制、金屬3D打印髖臼翼形鋼板治療復(fù)雜髖臼骨折,能對(duì)復(fù)雜髖臼柱骨折解剖復(fù)位,并達(dá)到堅(jiān)強(qiáng)的固定,真正實(shí)現(xiàn)復(fù)雜髖臼骨折的精準(zhǔn)化、個(gè)性化、微創(chuàng)化。
[Abstract]:Background pelvic and acetabular anatomical structures are complex. Traditional surgical approaches and internal fixation are difficult to meet the requirements of reduction and fixation for complex acetabular fractures involving tetrahedral bodies. The treatment of complex acetabular fractures with individualized plates is still blank. Objective to design a personalized acetabular winglike plate for patients with complex acetabular fractures, and to verify the feasibility and safety of the design method and manufacturing method by using metal 3D printing technology (SLM). The patients were followed up to evaluate their advantages and early therapeutic effects. Methods A complex acetabular fracture was reconstructed by digital three-dimensional reconstruction of the pelvis. The fracture was reduced and nailed. A completely anatomical individualized winglike plate was designed by using mirror image principle and reverse engineering technique. The design of individualized precision nail was carried out, and the metal 3D printing technology was used to make it, which was processed after processing, and the product was obtained. Ten individualized plates were designed and manufactured for 5 cadavers, and were implanted into the specimens by a single lateral approach of rectus abdominis to verify the feasibility of using this approach to implant the plates. The distance between the plate and the bony surface was measured to verify its compatibility. Twelve individualized plates were designed and fabricated in 12 patients with complex acetabular fractures and implanted into 3D printed pelvic models to verify the safety of screw hole design. From March 2016 to July 2016, we used lateral approach of rectus abdominis to expose and reposition, and 3D printing technology was used to assist simulation reduction, combined with individualized design. Clinical data of 8 cases of complex acetabular fractures treated with metal 3D printed acetabular wing plate fixation: male 4 cases female 4 cases; The average age was 57 years (31-76 years). According to Letournel-Judet classification, there were 2 cases with anterior posterior half transverse fracture and 6 cases with double column fracture, none of which involved posterior acetabular wall fracture or contralateral hemipelvic fracture. The operation was performed in the supine position under general anesthesia. The anterior rectus abdominis lateral incision approach was adopted. The anterior and posterior column fractures were reduced under direct vision. The customized plate was placed on the inner side of the acetabular. According to the position, direction and length of the screws set before the operation, the screws were inserted into the plates. After the C-arm X-ray machine fluoroscopy, fracture reduction and fixation were examined. Results the individual acetabular winglike plate was successfully designed and manufactured by using the above method. The average distance between the plate and the bone surface of the cadaveric specimen was about 1mm, and the average distance between the plate and the 3D printed pelvis model surface was about 0.7mm. All screws on the plate were not penetrated into the acetabular fossa. The operation was successfully completed in 8 cases. X-ray and CT showed that the acetabular anterior and posterior column fractures were well reduced and fixed, the individualized winglike plates were completely fitted to the bone surface, and there were no perioperative complications. According to the Matta imaging evaluation criteria: excellent in 3 cases, good in 4 cases, average in 1 case. The overall excellent and good rate was 87.5%; According to the improved Merled' Aubigne and Postel scoring system, the hip joint function was excellent in 5 cases, good in 2 cases, fair in 1 case, and the total excellent and good rate was 87.5%. Conclusion the application of mirror image principle and reverse engineering principle in the design of individualized bone-plate has a high degree of adhesion and the design of screw holes is safe and effective. The external incision of rectus abdominis combined with individualized design, personal customization, metal 3D printed acetabular wing plate for the treatment of complex acetabular fractures, can be anatomical reduction of complex acetabular column fractures, and achieve strong fixation. The complex acetabular fracture is truly accurate, individualized and minimally invasive.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.3
本文編號(hào)：2377507
[Abstract]:Background pelvic and acetabular anatomical structures are complex. Traditional surgical approaches and internal fixation are difficult to meet the requirements of reduction and fixation for complex acetabular fractures involving tetrahedral bodies. The treatment of complex acetabular fractures with individualized plates is still blank. Objective to design a personalized acetabular winglike plate for patients with complex acetabular fractures, and to verify the feasibility and safety of the design method and manufacturing method by using metal 3D printing technology (SLM). The patients were followed up to evaluate their advantages and early therapeutic effects. Methods A complex acetabular fracture was reconstructed by digital three-dimensional reconstruction of the pelvis. The fracture was reduced and nailed. A completely anatomical individualized winglike plate was designed by using mirror image principle and reverse engineering technique. The design of individualized precision nail was carried out, and the metal 3D printing technology was used to make it, which was processed after processing, and the product was obtained. Ten individualized plates were designed and manufactured for 5 cadavers, and were implanted into the specimens by a single lateral approach of rectus abdominis to verify the feasibility of using this approach to implant the plates. The distance between the plate and the bony surface was measured to verify its compatibility. Twelve individualized plates were designed and fabricated in 12 patients with complex acetabular fractures and implanted into 3D printed pelvic models to verify the safety of screw hole design. From March 2016 to July 2016, we used lateral approach of rectus abdominis to expose and reposition, and 3D printing technology was used to assist simulation reduction, combined with individualized design. Clinical data of 8 cases of complex acetabular fractures treated with metal 3D printed acetabular wing plate fixation: male 4 cases female 4 cases; The average age was 57 years (31-76 years). According to Letournel-Judet classification, there were 2 cases with anterior posterior half transverse fracture and 6 cases with double column fracture, none of which involved posterior acetabular wall fracture or contralateral hemipelvic fracture. The operation was performed in the supine position under general anesthesia. The anterior rectus abdominis lateral incision approach was adopted. The anterior and posterior column fractures were reduced under direct vision. The customized plate was placed on the inner side of the acetabular. According to the position, direction and length of the screws set before the operation, the screws were inserted into the plates. After the C-arm X-ray machine fluoroscopy, fracture reduction and fixation were examined. Results the individual acetabular winglike plate was successfully designed and manufactured by using the above method. The average distance between the plate and the bone surface of the cadaveric specimen was about 1mm, and the average distance between the plate and the 3D printed pelvis model surface was about 0.7mm. All screws on the plate were not penetrated into the acetabular fossa. The operation was successfully completed in 8 cases. X-ray and CT showed that the acetabular anterior and posterior column fractures were well reduced and fixed, the individualized winglike plates were completely fitted to the bone surface, and there were no perioperative complications. According to the Matta imaging evaluation criteria: excellent in 3 cases, good in 4 cases, average in 1 case. The overall excellent and good rate was 87.5%; According to the improved Merled' Aubigne and Postel scoring system, the hip joint function was excellent in 5 cases, good in 2 cases, fair in 1 case, and the total excellent and good rate was 87.5%. Conclusion the application of mirror image principle and reverse engineering principle in the design of individualized bone-plate has a high degree of adhesion and the design of screw holes is safe and effective. The external incision of rectus abdominis combined with individualized design, personal customization, metal 3D printed acetabular wing plate for the treatment of complex acetabular fractures, can be anatomical reduction of complex acetabular column fractures, and achieve strong fixation. The complex acetabular fracture is truly accurate, individualized and minimally invasive.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.3
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