【摘要】 目的探讨术前计算机辅助设计结合三维打印技术,制备个体化舟骨螺钉导向模板的可行性,并评估其辅助置钉的精确度。方法选取8例成人腕关节的标本,将其CT扫描数据导入VxWork软件,对舟骨进行三维重建,选取合适钉道,建立与腕关节周围皮肤相贴合的模具,并利用三维打印技术将其打印为导向模板。将此打印模板安置于尸体标本腕关节周围,经打印出的预置孔道打入螺钉导针。术后行CT扫描,对比术前术后的CT图像,对比导针的位置及打入深度的精确程度。结果螺钉导针位置精确度:6例偏差<1 mm,2例偏差<2 mm。导针打入深度:6例偏差<1 mm,2例偏差<2 mm。所有操作均为一次成功,且导针均在舟骨内,导针位置符合临床要求。结论本研究结果表明,基于CT图像,使用软件能够精确建立舟骨螺钉打入通道,三维打印出的个体化导航模板,辅助置钉准确性高、操作简单,为舟骨骨折螺钉的精确置入提供了一种可供选择的新方法。更多还原

【Abstract】 Objective To investigate the feasibility of establishing an individualized guide template for scaphoid screw insertion using computer-assisted design and three dimensional( 3D) printing technique, and to evaluate the accuracy and safety of this technique. Methods Eight adult wrist specimens were scanned by computed tomography( CT) scanner. All CT volume data of 8 wrists were imported into the Vx Work software and surface scaphoid models were reconstructed. We selected a proper tunnel of optimal screw guide wire position and then created a template matching to the wrist. A screw guiding template was created by 3D printing technique. Postoperative CT scans were obtained to evaluate the accuracy of screw position and insertion depth. Results A grading scheme was used to assess the drilling accuracy: Grade 1 < 1 mm deviation, Grade 2 < 2 mm deviation. Scaphoid drilling was conformed to be completely accurate( Grade 1) in 6 specimens, highly accurate( Grade 2) in 2 specimens. No specimen required a repeated drilling of the scaphoid. All the screws were in the scaphoid, whose positions met the clinical requirements. Conclusions This study has shown that a proper tunnel for scaphoid screw insertion can be created bases on CT scanning. Scahpoid screw insertion guided by a 3D printing template has been proved to be accurate and easy to operate and this technique could be a new alternative to conventional technique.更多还原