CAJ | 학술논문

目的：探讨3D打印技术辅助半肩置换的初步应用效果。方法对2010年9月至2013年10月收治的12例肱骨近端粉碎性骨折，患者进行上肢连续螺旋CT扫描，将原始．dicom格式数据导入Materialise Mimics 10．01软件，三维重建双上肢骨骼模型，以．stl格式保存，导入Geomagic Studio 11．0软件，在三维上确定肱骨的内外髁连线及肱骨头轴线，根据连线测量肱骨头高度及后倾角度，设计与结节间沟和假体近端解剖形态一致的导航模板，借助3D打印技术制作出实物模板，术中通过模板确定最佳假体高度及后倾角度，最后行肩袖修复。术后定时行患肢X线片检查，动态观察大小结节均愈合及假体位置变化情况，采用肩关节Neer评分标准评定术后肩关节功能。结果12例患者术后获得10～34个月（平均16．8个月）随访，12例患者（12肩）大小结节均获骨性愈合，愈合时间为3～4个月，平均为3．4个月。末次随访肩关节Neer评分标准评定疗效：优8例，良3例，可1例，优良率为91．67％。结论通过将3D打印技术和计算机辅助设计相结合设计个体化导航模板，可大大提高半肩置换中假体高度及后倾角度的精确性，使患者获得更好的活动功能，为半肩置换术提供了一种新的简单、有效的方法。
목적：탐토3D타인기술보조반견치환적초보응용효과。방법대2010년9월지2013년10월수치적12례굉골근단분쇄성골절，환자진행상지련속라선CT소묘，장원시．dicom격식수거도입Materialise Mimics 10．01연건，삼유중건쌍상지골격모형，이．stl격식보존，도입Geomagic Studio 11．0연건，재삼유상학정굉골적내외과련선급굉골두축선，근거련선측량굉골두고도급후경각도，설계여결절간구화가체근단해부형태일치적도항모판，차조3D타인기술제작출실물모판，술중통과모판학정최가가체고도급후경각도，최후행견수수복。술후정시행환지X선편검사，동태관찰대소결절균유합급가체위치변화정황，채용견관절Neer평분표준평정술후견관절공능。결과12례환자술후획득10～34개월（평균16．8개월）수방，12례환자（12견）대소결절균획골성유합，유합시간위3～4개월，평균위3．4개월。말차수방견관절Neer평분표준평정료효：우8례，량3례，가1례，우량솔위91．67％。결론통과장3D타인기술화계산궤보조설계상결합설계개체화도항모판，가대대제고반견치환중가체고도급후경각도적정학성，사환자획득경호적활동공능，위반견치환술제공료일충신적간단、유효적방법。
Objective To study the clinical effects of a new method using three-dimentional (3D) printing technology for hemiarthroplasty in the treatment of proximal humeral fracture .Methods From Sept 2010 to Oct 2013, 12 cases of proximal humeral fracture were admitted .All the patients were examined by the continual spiral CT scan to harvest the original data of upper limbs .The 3D reconstruction of the bone was performed by Materialise Mimics 10.01 software.The 3D models were imported into Geomagic Studio 11.0 sofeware to measure the humeral head retroversion and the height of the humerus . The retroversion angles and the heights of the prosthesis were precisely determined in the proximal humeral fracture according to the computer aided measurement .The cloud data of the surface points were collected to design individual assisting templates for hemiarthroplasty by Geomagic Studio 11.0 sofeware.The physical templates were built using 3D printing technology .In the operation, the best location of the prosthesis was determined according to the templates , then both bone cement fixation and rotator cuff repair were performed .Retroversion angles and heights of the prosthesis were measured by postoperative X -ray images of the shoulder joint .Neer score was used to evaluate the preoperative and postoperative functions of the shoulder joint .Results All the patients were followed up form 10 to 34 months ( average 16.8 months);the bony union time of the fracture was three to four months (average 3.4 months).According to the Neer score at the latest follow-up,eight cases were excellent , three cases were good , one cases was fair , and the good and excellent rate was 91.67%.Conclusion The individual templates of computer-aided design combining 3D printing technology can greatly improve the accuracy of the implants position and achieve better motion of shoulder joint , which provides a simple and effective new method for hemiarthroplasty of proximal humeral fracture .