3D打印结合内固定模型库辅助复杂胫骨平台骨折精确化内固定手术
PDF下载 (374)黄华军,曾参军,张雁儒.3D打印结合内固定模型库辅助复杂胫骨平台骨折精确化内固定手术[J].宁波大学学报(理工版),2019,32(6):23-29.DOI:
Huang Huajun,Zeng Canjun,Zhang Yanru.Precision surgery of complicated tibial plateau fracture assisted by 3D implant library and 3D-printed navigational template[J].Journal of Ningbo University(Natural Science & Engineering Edition),2019,32(6):23-29.DOI:
| Title: | Precision surgery of complicated tibial plateau fracture assisted by 3D implant library and 3D-printed navigational template |
| 作者: | 黄华军, 曾参军, 张雁儒 |
| Author(s): | Huang Huajun, Zeng Canjun, Zhang Yanru |
| 关键词: | 胫骨平台骨折; 内固定; 3D打印; 计算机辅助; 术前规划 |
| Keywords: | tibial plateau fracture; internal fixation; 3D printing; computer-assisted; preoperative planning |
| 分类号: | R683.4 |
| 文献标识码: | A |
| 摘要: | 本研究旨在通过应用3D打印导航模板辅助复杂胫骨平台骨折内固定植入手术, 提高内固定手术的精确性. 采用5例正常膝关节尸体标本进行Schatzker V型骨折造模, 骨折模型进行CT扫描三维重建, 结合钢板模型库进行虚拟个性化内固定手术. 根据虚拟的优化内固定手术方案设计并3D打印个性化导航模板, 引导现实的骨折标本内固定手术. 通过虚拟术前规划(术前)和标本实验(术后)的螺钉长度、进钉点位置以及方向的对比分析来评估内固定效果, 结果提示本实验获得了优化、精确的内固定效果. 螺钉长度差异为(0.89±2.94)mm, p>0.05; x, y和z轴进钉点差异分别为(1.19±1.31), (1.73±1.31)和(1.22±0.88)mm, p>0.05; 冠状面(x-y)和横断面(x-z)的投影角差异分别为(2.99±2.98)°和(1.57±5.13)°, p>0.05. 以螺钉长度、进钉点位置和钉道投影角进行评估术前和术后的钉道差异, 结果提示二者无明显差异. 在钢板模型库和个性化导航模板的辅助下可以获得理想和精确的内固定植入方案, 提高个性化内固定手术的精确性和有效性 |
| Abstract: | This study is aimed to improve the precision of 3D-printed navigational template for plating and screwing procedures during surgery for complicated tibial plateau fracture. Five normal cadaveric knee specimens were scanned using computed tomography (CT) and reconstructed into volume models. Virtual Schatzker classification of V tibial plateau fractures were modeled based on the 3D models. The classifications were used to perform personalized preoperative planning of plating and screwing procedures assisted by the library of implant models. According to the optimal planning, patient-specific navigational templates were used to produce a 3D print in order to guide the real cadaveric surgical implantation. The analysis of fixation efficacy in terms of the deviations of screw placement between preoperative and postoperative screw trajectories were measured and compared. Furthermore, the screw lengths, entry point locations and screw directions can be precisely determined. With preoperative planning, optimized and precise fixation results were achieved in real cadaveric surgeries and clinical surgeries. In the cadaveric study, the deviations of screw length were (0.89±2.94) mm, p>0.05. The displacements of entry point in the x-, y-, and z-axis were (1.19±1.31), (1.73±1.31) and (1.22±0.88)mm, respectively, p>0.05. The deviations of projection angle in the coronal (x-y) and transverse (x-z) planes were (2.99±2.98)° and (1.57±5.13)°, respectively, p>0.05. The precision of screw placement with respected to deviations of screw length, entry point and projection angle between the ideal and actual screw trajectories revealed no significant difference. The ideal and precise preoperative planning of plating and screwing can be achieved in the real surgery assisted by the 3D models library of implants and the patient- specific navigational template. This technology improves the precision and efficiency of personalized internal fixation surgery |
| 参考文献 /References: | [1].Guo Y D, Wang C. Challenges in management of complex tibial plateau fracture[J]. China Journal of Orthopaedics and Traumatology, 2017, 30(10):881-884. [2].Ramponi D R, McSwigan T. Tibial plateau fractures[J]. Advanced Emergency Nursing Journal, 2018, 40(3):155- 161. [3].Zhao R, Lin Z, Long H, et al. Diagnosis and treatment of hyperextension bicondylar tibial plateau fractures[J]. Journal of Orthopaedic Surgery and Research, 2019, 14(1):191. [4].Chen H, Wu L. Surgical options for posterior tibial plateau fracture[J]. International Journal of Clinical and Experimental Medicine, 2015, 8(11):21421-21427. [5].Krause M, Muller G, Frosch K H. Surgical approaches to tibial plateau fractures[J]. Der Unfallchirurg, 2018, 121 (7):569-582. [6].Zhang Y, Wang Q, He X F, et al. Surgical methods and curative effect of tibial plateau fracture with medial large block split[J]. China Journal of Orthopaedics and Traumatology, 2018, 31(9):853-857. [7].Zhao G, He Q, Duan H, et al. Treatment of posterolateral tibial plateau fractures through fibular osteotomy approach[J]. Acta Orthopaedica Belgica, 2019, 85(1):114- 121. [8].Citak C, Kayali C, Ozan F, et al. Lateral locked plating or dual plating: A comparison of two methods in simple bicondylar tibial plateau fractures[J]. Clinics in orthopedic surgery, 2019, 11(2):151-158. [9].任威. 双切口双钢板内固定治疗复杂胫骨平台骨折的效果的相关研究[J]. 世界最新医学信息文摘, 2019, 19(45):19-20. [10].Ye X, Huang D, Perriman D M, et al. Influence of screw to joint distance on articular subsidence in tibial-plateau fractures[J]. ANZ Journal of Surgery, 2019, 89(4):320- 324. [11].Jian Z, Ao R, Zhou J, et al. A new anatomic locking plate for the treatment of posterolateral tibial plateau fractures [J]. BMC Musculoskeletal Disorders, 2018, 19(1):319. [12].Wang Z, Tang Z, Liu C, et al. Comparison of outcome of ARIF and ORIF in the treatment of tibial plateau fractures[J]. Knee Surgery, Sports Traumatology, Arthroscopy, 2017, 25(2):578-583. [13].Uehara M, Takahashi J, Hirabayashi H, et al. Computer- assisted C1-C2 transarticular screw fixation “Magerl technique” for atlantoaxial instability[J]. Asian Spine Journal, 2012, 6(3):168-177. [14].Hu Y, Li H, Qiao G, et al. Computer-assisted virtual surgical procedure for acetabular fractures based on real CT data[J]. Injury, 2011, 42(10):1121-1124. [15].Fornaro J, Keel M, Harders M, et al. An interactive surgical planning tool for acetabular fractures: Initial results[J]. Journal of Orthopaedic Surgery and Research, 2010, 5:50. [16].Kwon S Y, Kim Y, Ahn H W, et al. Computer-aided designing and manufacturing of lingual fixed orthodontic appliance using 2D/3D registration software and rapid prototyping[J/OL]. International Journal of Dentistry, 2014, 2014:164164 [2018-09-12]. http://10.1155/2014/ 164164. [17].Merc M, Drstvensek I, Vogrin M, et al. Error rate of multi-level rapid prototyping trajectories for pedicle screw placement in lumbar and sacral spine[J]. Chinese Journal of Traumatology, 2014, 17(5):261-266. [18].Yin Q, Liu W, Wang S. Application of customized augments fabricated by rapid prototyping for severe bone defects of the knee[J]. Chinese Medical Journal, 2014, 127(15):2870-2871. [19].Cornell C N, Levine D, Pagnani M J. Internal fixation of proximal humerus fractures using the screw-tension band technique[J]. Journal of Orthopaedic Trauma, 1994, 8(1): 23-27. [20].Babb J D, Parr G V, O’Neill M J, Jr. Predicting aortic valve prosthesis size. A step toward better matching of patient and prosthesis[J]. The Journal of Thoracic and Cardiovascular Surgery, 1981, 81(3):451-454. [21].Vibert B, Pailhe R, Morin V, et al. Navigation for lower limb alignment during internal fixation of complex tibial-plateau fractures[J]. Orthopaedics & Traumatology: Surgery & Research, 2018, 104(4):491-496. |
| 备注/Memo: | 基金项目: 广东省医学科学技术研究基金（A2016521）广东省科技计划（2017B090912002）天河区科技计划（医疗卫生专项）重点项目（2018YZ011）南方医科大学临床研究启动计划（LC2016PY045）.
宁波大学学报（理工版）网址：http://journallg.nbu.edu.cn/第一作者: 黄华军（1983－）, 男, 广东湛江人, 博士/主治医师, 主要研究方向: 创伤骨科. E-mail: tianjixuanying@163.com *通信作者: 张雁儒（1970－）, 男, 河南西华人, 教授, 主要研究方向: 创伤骨科. E-mail: zhangyanru@nbu.edu.cn |
