Journal of Nanchang University Medical Sciences 2018 Vol.58 No.6 39 CT 3D CT 3D D AO /ASIF B 3 C 38 CT 3D sarmiento

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1 Journal of Nanchang UniversityMedical Sciences2018 Vol.58 No.6 39 CT 3D CT 3D D AO /ASIF B 3 C 38 CT 3D sarmiento Dienst 41 49±17min 39±21 ml 98.5%40 8.7± % ±2.6mm 11.3± ± %39 3D 3D CT R DOI /j.cnki.ncdm A Adjuvant Treatment of Intra-Articular Distal Radius Fractures with 3D Printing Based on CT Scan CHENG Xiang-yu JI BinWANG Zhen PAN Wei-cheng LU Wei-jia ZHANG Shai-linWANG Wen-yan SONG Kun PANG Jin-hui Department of Orthopedics Putuo Hospital Shanghai University of Traditional Chinese Medicine Shanghai China ABSTRACTObjective To evaluate the clinical value of 3D printing based on CT scan in the adjuvant treatment of intra-articular distal radius fractures.methods From April 2013 to September patients with intra-articular distal radius fractures3 patients with AO /ASIF type B fractures and 38 patients with AO /ASIF type C fracturesunderwent open reduction and internal fixation assisted by CT scanbased 3D printing.according to CT scan data the models of fractures used for classification were produced by 3D printer.the virtual surgery was carried out with computer. The real surgical procedures were performed accurately according to the pre-operative planning.bone plate type screw length operation time intraoperative blood loss and healing time were recorded and postoperative reduction effectimproved Sarmiento systemand wrist functiondienst criterionwere evaluated in all patients.results The operation time and intraoperative blood loss were49±17minutes and39±21ml respectively.the type of PTZK04 PTKWWS pjhmc@ 163.com

2 40 bone plate used in actual operation was same as that used in simulated surgery. The accuracy of screw length reached 98.5%40 cases.all fractures healed after8.7±1.1weeks.the excellent and good rate was 92.7%38 casesfor fracture reduction and 95.1%39 casesfor wrist function.the radial height palmar tilt and ulnar inclination were0.6±2.6mm 11.3±3.4 and21.2±5.4 respectively.conclusion The 3D printing technology can rapidly create fracture model which can help surgeons have a direct visualization of intra-articular distal radius fractures. In addition virtual surgery provides patientspecific preoperative planning for accurate surgery which improves the efficiency and therapeutic efficacy of actual operation. KEY WORDSdistal radius fracture3d printingct scaninternal fixation 74.5% ~ X CT CT AO /ASIF 3 B1 1 3D B3 2 C1 13 C2 16 C3 9 1 ~ 51.9±0.7d CT 0.5 mm 1 > DICOM AO /ASIF B Mimics C 3 4 3D D D X CT 1 3D 2 3D Mimics 4 DVR TM

3 CT 3D d 24 h X sarmiento 4 8 cm sarmiento 0 1 ~ 3 4 ~ 6 7 ~ 12 = + / 100% cm 1 Dienst 5 15 DVR TM 15 ~ ~ 50 = + / 100% ±17min

4 42 南昌大学学报医学版 2018 年 12 月第 58 卷第 6 期为 39±21 ml 实际手术采用的接骨板规格与术前计划完全一致螺钉长度的准确率达 98 5% 40 例随访时间为 15 3 ± 3 7 个月患者骨折全部顺利愈合愈合时间为 8 7±1 1 周影像学方面于术后 6 个月随访时摄 X 线片测量桡骨远端的复位情况未见螺钉进入关节腔桡骨茎突高度 10 6±2 6 mm 掌倾角为 11 3±3 4 尺偏角为 21 2± 例患者复位效果优 27 例良 11 例可 3 例优良率 92 7%通过与术后即刻的 X 线片比较未见骨折复位丢失内植物松动等情况腕关节功能总的优良率达 95 1% 其中优 28 例良 11 例可 2 腱断裂等并发症 3 典型病例患者女 59 岁因不慎跌倒致右桡骨远端骨折 AO / ASIF 分类 C 型入院后拍摄 CT 三维重建如图 6 所示根据 CT 扫描数据 3D 打印骨折实体模型并于计算机行体外模拟复位内固定手术制定手术计划并记录内植物规格相关资料如图 1 5 所示参考模拟手术情况为患者实施精准的内固定术所用内植物规格均与模拟手术记录一致于术后 0 3 个月随访腕关节功能良好术后 X 线表现见图 7 例未见伤口感染正中神经损伤内固定失效肌图6 术前的 X 线表现和 CT 三维重建 A 术后即刻 B 术后 1 个月 C 术后 2 个月 D 术后 3 个月图7 4 术后 X 线正位侧位表现讨论桡骨远端骨折指骨折线距关节面 3 cm 以内的桡骨远端骨折以中老年女性多见本研究中 60 岁以上女性达 24 例病因以低能量的跌伤最为常见 6-7 准为腕关节功能最大程度的恢复打下基础由于接骨板具备固定牢靠可以早期锻炼等明显优势被越来越普遍地应用于桡骨远端骨折的治疗桡骨远端背侧被很多伸肌腱所覆盖接骨板放 8 置在背侧容易导致肌腱粘连甚至断裂等情况对于粉碎性骨折或骨质疏松明显的病例非锁定的普本文有 30 例患者因低能量损伤导致桡骨远端骨折近年来因高处坠落车祸等原因所致青壮年桡骨远端骨折有所增加此类高能量损伤往往导致关节面通钢板容易出现螺钉松动退出从而导致内固定失效掌侧锁定接骨板很好地解决了上述问题能保完全粉碎本研究中有 9 例属高能损伤造成的 C 型骨折对于不稳定的桡骨远端关节内骨折应采取复以争取达到解剖标位效果确切的切开复位内固定术但是桡护钢板下骨的血运被临床普遍接受骨远端关节内骨折的骨折线涉及关节面应用掌侧锁定板内固定也无法完全避免复位不佳螺钉穿入 7 9

5 CT 3D 43 CT 3D % 95.1% Burke F D. Functional cast-bracing for Colles fractures. A comparison between cast-bracing and conven- 3D J.J Orthop Trauma Stewart H D Innes A R CT tional plaster castsj Mimics Dienst M Wozasek G E 11 3D Mimics J ±17min 39±21mL 3D multicenter prospective study J J. 2. DVR C J No authors listed.fracture and dislocation compendium.orthopaedic trauma association committee for coding and classification 10S 1 ⅴ-ⅸ J Bone Joint Surg Br Seligson D. Dynamic external fixation for distal radius fracturesj.clin Orthop Relat Res DVRTM J. Meta J Matschke S Marent Huber M Audigé L et al. The surgical treatment of unstable distal radius fractures by angle stable implantsa.j Orthop Trauma D J Mimics Henry C J CT 3D 12 J 櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐櫐 38.3D 7. J J J Naik P P Ghadge M S Raste A S. Lipid profile in leukemia and Hodgkin s disease J.Indian J Clin Biochem J J Rojewski M T Krper S Schrezenmeier H.Arsenic trioxide therapy in acute promyelocytic leukemia and beyondfrom bench to bedside J.Leuk Lymphoma J S J

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