【摘要】 目的探索应用3D打印导板结合数字技术辅助手术治疗复杂距骨骨折的方法。方法选取2013年1月至2017年6月收治的复杂距骨骨折病例15例,男性13例,女性2例;年龄16～57岁,平均年龄36.8岁。将患者的薄层CT扫描数据导入Mimics软件,构建距骨骨折的三维模型。在Solidworks软件中建立螺钉的三维数字模型导入Mimics,模拟手术入路、复位、固定骨折块,设计、打印导板。术中根据数字技术模拟的方案选择入路、复位骨折,根据螺钉导板选择合适的螺钉和角度固定骨折。术后将骨折复位内固定结果与术前方案比较,随访患者远期踝关节功能,评价3D打印结合数字技术治疗复杂距骨骨折的效果。结果 15例患者解剖复位10例,良好3例,可2例。螺钉安放与术前设计基本一致,无螺钉误入关节、长度合适。美国足踝外科协会(American orthopaedic foot and ankle society,AOFAS)踝-后足评分:优9例,良4例,可2例。结论 3D打印结合数字技术为复杂距骨骨折的术前设计、术中植入螺钉提供了直观、有效的手段,能提高手术内固定的精确性。更多还原

【Abstract】 Objective To explore the application of combining 3D-printed drill guide and digital technology in the treatment of complex talus fractures.Methods Thin-section CT data of 15 cases of talus fractures were obtained and imported into Mimics(Materialise’s interactive medical image control system),and three-dimensional(3D) models of fractures were reconstructed.The mean age was 36.8(16～57)years,and there were 13 males and 2 females.Solidworks files of screws were drawn and imported into Mimics.Virtual reduction and internal fixation were performed in Mimics,which served as a guidance for operation in surgical approach,reduction,appropriate screw and angle of fixation.3D drill guides were designed and exported to Maker Bot Replicator Z18 3D printer,where 3D drill guides were printed.The postoperative X-ray were compared with digital models and the efficacy of combining 3D-printed drill guide and digital technologies was assessed.Long-term function of ankle joint was followed-up.Results Anatomic reduction was achieved in 10 cases,good reduction in 3 cases,fair reduction in 2 cases.The positions of internal fixation were very closed to preoperative planning.No screws penetrated into ankle joints and the lengths of screws are suitable.According to the AOFAS Ankle Hindfoot Scale,9 cases were excellent,4 cases were good and 2 cases were fair.Conclusion The 3D-printed drill guide and digital technologies provides an effective means for preoperative design,surgery simulation and accurate fixation of complex talus fractures.更多还原