CAJ | 학술논문

目的探讨利用计算机辅助设计和3D打印制作的个体化手术导板实现骶髂螺钉精确置入的可行性.方法选取1例骨盆骨折患者,男性,35岁,术前行CT检查示骨盆后环损伤,经骶孔骶骨骨折;Denis等分型为Ⅱ区骨折,骨盆前环为对侧耻骨上下支骨折.依据CT数据使用3D打印机打印个体化骨盆模型,通过软件设计并打印出骶髂螺钉置入导板,3D打印导板通过术前预试验验证可行后,术中在导板辅助下置入骶髂螺钉.结果 3D打印的骨盆模型及个体化设计定制的手术导板能够满足骶髂螺钉精确置入的要求,螺钉置入后经术后X线及CT证实与术前设计一致,导板与骨性标志匹配良好.骶髂螺钉置入的手术时间约为30 min,术中出血量约为50 ml,术中仅使用CT透视两次,术后伤口一期愈合.术后X线片示应用骶髂螺钉导板辅助置入骶髂螺钉的进钉点、进钉方向均与术前设计方案一致,螺钉在骶髂关节内位置良好,未见螺钉穿破骶骨侧块皮质.术后3个月随访,骨盆骨折临床愈合,按Matta功能评分系统评价骨盆骨折术后功能情况为满意,螺钉无松动、断裂,骨折愈合良好,未发生浅表及深层感染.结论利用计算机辅助设计、3D打印技术打印的个体化骨盆模型及手术导板不但可以实现骶髂螺钉的精确置入,而且节省了手术时间,减少了患者及手术操作入员的射线暴露风险.
목적 탐토이용계산궤보조설계화3D타인제작적개체화수술도판실현저가라정정학치입적가행성.방법 선취1례골분골절환자,남성,35세,술전행CT검사시골분후배손상,경저공저골골절;Denis등분형위Ⅱ구골절,골분전배위대측치골상하지골절.의거CT수거사용3D타인궤타인개체화골분모형,통과연건설계병타인출저가라정치입도판,3D타인도판통과술전예시험험증가행후,술중재도판보조하치입저가라정.결과 3D타인적골분모형급개체화설계정제적수술도판능구만족저가라정정학치입적요구,라정치입후경술후X선급CT증실여술전설계일치,도판여골성표지필배량호.저가라정치입적수술시간약위30 min,술중출혈량약위50 ml,술중부사용CT투시량차,술후상구일기유합.술후X선편시응용저가라정도판보조치입저가라정적진정점、진정방향균여술전설계방안일치,라정재저가관절내위치량호,미견라정천파저골측괴피질.술후3개월수방,골분골절림상유합,안Matta공능평분계통평개골분골절술후공능정황위만의,라정무송동、단렬,골절유합량호,미발생천표급심층감염.결론 이용계산궤보조설계、3D타인기술타인적개체화골분모형급수술도판불단가이실현저가라정적정학치입,이차절성료수술시간,감소료환자급수술조작입원적사선폭로풍험.
Objective To investigate the feasibility and accuracy of a drill template for the placement of iliosacral screws based on digital design and 3D printing technology.Methods The preoperative CT images of a 35-year-old male patient with pelvic fracture were collected.According to the Dennis classification,the type of pelvic posterior ring fracture was sacral region Ⅱ.The pelvic front ring fracture involved the contralateral superior ramus and inferior ramus of the pubis.The data was reconstructed by 3D imaging reconstruction workstation.The operation was simulated and the individual drill template was designed on the virtual 3D model according to the surgical procedure.With the 3D printing technology,the individual drill template and the solid pelvic model were produced.Results Preoperative simulation with the 3D printed solid model confirmed the effectiveness of the template.During the surgery,the drill template was used to guide the placement of iliosacral screws.The implantation of iliosacral screw cost 30 min,with intraoperative blood loss of 50 ml and no blood transfusion.The wound healed primarily.Intraoperative CT was used only once after the entire pedicle screw had been inserted.The method significantly reduced operation time and radiation exposure for the members of the surgical team.Drill template was used in case of iliosacral screws implantation.The entry point and orientation of the screws were all consistent with virtual schemes.The position of pedicle screw was good and no screw worn out of the pedicle cortex.3D printed pelvic model and individual designed drill template were technically feasible and result in accurate and precise screw placement.Overall,iliosacral screw was placed and the accuracy of screw placement was confirmed with postoperative X-ray and CT scanning.Template and the corresponding anatomical landmark fitted well.A 3-month follow-up demonstrated properly functional recovery was reached.No biological complications were encountered and no implant failures occurred during the entire follow-up period.Conclusion By means of digital design and 3D printing technology,accurate placement of individualized iliosacral screws can be realized.This technology improves the safety profile of this fixation technique and should be further studied in clinical applications.