金屬3D打印個性化髖臼翼狀接骨板的研發(fā)及實驗研究
發(fā)布時間：2018-12-14 00:01
【摘要】：研究背景骨盆、髖臼解剖結構復雜,對于累及四邊體的復雜髖臼骨折,傳統(tǒng)手術入路及內(nèi)固定難以滿足復位、固定要求,采用個性化接骨板治療復雜髖臼骨折尚處于空白。研究目的針對復雜髖臼骨折患者設計個性化髖臼翼狀接骨板,使用金屬3D打印技術(SLM)制造,對該設計方法和制造方式進行可行性及安全性驗證,經(jīng)驗證成功后將其應用于臨床,對患者進行隨訪研究,評價其優(yōu)勢及早期臨床治療療效。研究方法對某一復雜髖臼骨折患者骨盆數(shù)字化三維重建,對骨折進行模擬復位、置釘,利用鏡像原理及逆向工程技術,設計完全解剖型的個性化翼狀接骨板,并進行個性化精準置釘設計,采用金屬3D打印技術制造,對其進行后加工處理,得到產(chǎn)品。對5具尸體標本采用上述方法設計并制造10塊個性化接骨板,采用單一腹直肌外側入路將其植入到標本中,驗證使用該入路植入接骨板的可行性,測量接骨板與貼合骨面的距離,驗證其貼合性;對12名復雜髖臼骨折患者采用上述方法設計并制造12塊個性化接骨板,將其植入到3D打印骨盆模型中,驗證螺釘孔設計的安全性�；仡櫺苑治�2016年3月～2016年7月,采用經(jīng)腹直肌外側入路顯露、復位,使用3D打印技術輔助模擬復位,結合個性化設計、金屬3D打印髖臼翼形接骨板固定治療8例復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側半骨盆骨折。手術在插管全麻下平臥位進行,經(jīng)前方腹直肌外側切口入路,直視下對髖臼前、后柱骨折進行復位,將個性化設計定制的鋼板放置于髖臼的內(nèi)側面,檢查鋼板與骨面的貼合程度,再按術前設定的螺釘位置、方向、長度置入螺釘,C形臂X光機透視后,檢查骨折復位、固定情況。結果采用上述方法成功設計并制造出個性化髖臼翼狀接骨板,接骨板與尸體標本骨面平均距離在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。術后X線及CT顯示髖臼前后柱骨折復位固定良好,個性化翼狀接骨板與骨面完全貼合,無圍手術期并發(fā)癥發(fā)生,按照Matta影像學復位評估標準:優(yōu)3例,良4例,一般1例,總體優(yōu)良率87.5%;隨訪9～12個月,骨折均愈合;根據(jù)改良的Merled' Aubigne和Postel評分系統(tǒng),髖關節(jié)功能:優(yōu)5例,良2例,可1例,總優(yōu)良率87.5%。結論應用鏡像原理和逆向工程原理設計的個性化接骨板貼合度高,螺孔設計安全有效;經(jīng)腹直肌外側切口入路結合個性化設計、私人定制、金屬3D打印髖臼翼形鋼板治療復雜髖臼骨折,能對復雜髖臼柱骨折解剖復位,并達到堅強的固定,真正實現(xiàn)復雜髖臼骨折的精準化、個性化、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.
【學位授予單位】：南方醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R687.3
本文編號：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.
【學位授予單位】：南方醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R687.3
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