计算机辅助设计3D 打印技术在复杂跟骨骨折治疗中的应用

摘要

Objective To investigate the feasibility of computer aided design and three‐dimensional (3D) printing technology in the treatment of complex calcaneus fractures .Methods Data of 5 patients undergoing surgical treatment of calcaneal fractures of Sanders Ⅲ and Ⅳwith computer aided design and 3D printing technology from June 2015 to May 2016 were retrospectively analyzed .Dual‐source thin‐section CT and computerized aided mirror imaging were used .The morphological changes of the calcaneus before and after injury were contrasted to create a 3D model of the calcaneal fractures with the help of computer rapid imaging technology .An appropriate plate was selected and shaped on the calcaneus model before injury ,and surgical operation on the calcaneus model after injury was simulated .Surgical treatment time and the fracture reduction ,preoperative and postoperative Bohler angle ,Gissane angle and American Orthopaedic Foot and Ankle Society (AOFAS) ankle‐hindfoot scores were compared .Results Pre‐reshaped plates matched well with the calcaneus after surgical reduction .The operation time was shortened ,with minimal injury to the surrounding soft tissue . The incisions healed uneventfully and patients were satisfied with the postoperativefunction.Bohlerangleswere7.7°±1.5°preoperativelyand27.9°± 5.3°postoperatively(t= -11.5,P<0.05);Gissaneangles were 165 .4° ± 11 .2° preoperatively and 112 .9° ± 5 .5° postoperatively (t= 13 .3 ,P< 0 .05);AOFAS ankle‐hindfoot scores were 17 .9 ± 2 .5 preoperatively and 74 .1 ± 7 .3 postoperatively (t= -23 .1 ,P<0 .05) .Conclusion Computer aided design and 3D printing technology helps to evaluate the fracture displacement preoperatively and customize individualized surgical plans ,thus improving surgical outcome .%目的探讨计算机辅助设计3D打印技术在复杂跟骨骨折治疗中的应用。方法回顾性分析2015年6月至2016年5月采用计算机辅助设计3D打印技术行手术治疗的5例Sanders Ⅲ、Ⅳ型跟骨骨折患者资料。术前对双侧跟骨行双源薄层CT扫描，应用计算机辅助镜面成像技术对患者健侧跟骨进行镜像处理，得到患侧跟骨受伤前形状。对比患侧跟骨受伤前后形态变化，应用计算机快速成型技术用3D打印机打印出患侧受伤前后模型。选择合适大小的接骨板，在受伤前跟骨模型上预塑形接骨板，并在骨折模型上模拟手术复位操作。记录手术时间、复位情况，比较手术前后Bohler角、Gissane角及美国足踝外科学会（AOFAS）踝‐后足评分。结果预塑形钢板与术中复位的跟骨匹配，手术时间缩短，且减少了周围软组织损伤，无术后皮瓣并发症发生，患者术后恢复良好。手术前后Bohler角分别为7．7°±1．5°、27．9°±5．3°（t＝－11．5，P＜0．05），Gissane角分别为165．4°±11．2°、112．9°±5．5°（t＝13．3，P＜0．05）；手术前后AOFAS踝‐后足评分分别为（17．9±2．5）分、（74．1±7．3）分（t＝－23．1，P＜0．05）。结论计算机辅助设计与3D打印技术结合，可在术前直观地观察患者骨折移位情况，并精确定制个体化手术方案，提高手术精度与安全性。