2018 58 6 Journal of Nanchang UniversityMedical Sciences2018 Vol.58 No.6 39 CT 3D 200062 CT 3D 2013 4 2016 9 41 3D AO /ASIF B 3 C 38 CT 3D sarmiento Dienst 41 49±17min 39±21 ml 98.5%40 8.7±1.1 92.7%38 10.6±2.6mm 11.3±3. 4 21.2±5.4 95.1%39 3D 3D CT R683.41 DOI10.13764 /j.cnki.ncdm.2018.06.009 A 2095-4727201806-0039-05 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 200062 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 2016 41 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 2018-03-06 15411970100 2016PTZK04 PTKWWS201705 315 1976 E-mailpjhmc@ 163.com
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% 41 13 28 19 ~ 76 52.9 60 26 1 30 5 6 29 12 2 X CT CT AO /ASIF 3 B1 1 3D B3 2 C1 13 C2 16 C3 9 1 ~ 51.9±0.7d 1 1.1 CT 0.5 mm 1 >18 2 512 512 DICOM AO /ASIF B Mimics C 3 4 3D 1 2 1 1 3D 1 3 4 1.2 2 2013 4 2016 9 1.3 1.3.1 3D 2018 12 58 6 X CT 1 3D 2 3D 1.3.2 3 Mimics 4 DVR TM
CT 3D 41 5 5 1.4 3 4 1.4.2 1 d 24 h 2 6 4 8 12 X 3 1 1.5 1.4.1 1.5.1 sarmiento 4 8 cm 0 1 2 4 3 sarmiento 0 1 ~ 3 4 ~ 6 7 ~ 12 = + / 100% 2.0 1.5.2 cm 1 Dienst 5 15 DVR TM 15 ~ 30 30 ~ 50 = + / 100% 2 41 49±17min
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±5 4 41 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
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