王文;左贵来;王凡;仲伟波;张谦;

• 1:山东省千佛山医院骨创伤外二科

摘要(Abstract)：

[目的]评估3D打印手术导板结合桥接内固定系统异型块技术治疗股骨复杂骨折。[方法]采用此技术治疗股骨粉碎性闭合性复杂骨折患者7例,年龄26~45岁,平均35岁。患肢进行螺旋CT扫描后,采用Mimics软件处理DICOM数据。骨折虚拟复位后,将股骨桥接棒远近段异型块STL文件导入,设计并打印远近段手术导板。术中暴露出股骨远近端皮质,在导板引导下置放桥接棒异型块,连接桥接棒完成间接复位骨折。同时异型块的螺钉也能固定髁部或粗隆间骨折。采用Warden的4-point radiographic scoring system对术后1个月的X线片骨折愈合骨痂评分程度进行评分。[结果]7例完全采用了计划固定方法,患者术中采用的异型块位置与桥接棒长度均与术前计划一致。术中C型臂X线机透视及术后随访X线片及CT显示7例均达到了生物学复位。无明显短缩及旋转移位。术后1个月随访见股骨骨折部均出现明显骨痂生长。Warden评分均为2分。[结论]该方法能够顺利完成股骨全长骨折固定,同时缩短手术时间,骨折段达到生物学固定,术后1个月骨痂生长明显。

关键词(KeyWords)： 复杂股骨骨折;桥接内固定系统;异型块;3D打印技术;手术治疗

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 王文;左贵来;王凡;仲伟波;张谦;

Email:

DOI:

参考文献(References)：

• [1]赵烽,熊鹰,张武,等.桥接组合式内固定系统治疗股骨干粉碎性骨折[J].中国骨科临床与基础研究杂志,2013,5(5):268-272.
• [2]刘琨,赵汝岗,张强.3D打印技术在骨科的应用研究进展[J].中华创伤骨科杂志,2015,17(10):63-65.
• [3]You W,Liu LJ,Chen HX,et al.Application of 3D printing technology on the treatment of complex proximal humeral fractures(Neer3-part and 4-part)in old people.[J].Orthop Traumatol Surg Res,2016,102(7):897-903.
• [4]Chung KJ,Huang B,Choi CH,et al.Utility of 3D printing for complex distal tibial fractures and malleolar avulsion fractures:technical tip[J].Foot Ankle Int,2015,36(12):1504-1510.
• [5]Kunz M,Ma B,Rudan JF,et al.Image-guided distal radius usteotomy using patient-specific instrument guides[J].J Hand Surg Am,2013,38(8):1618-1624.
• [6]Tricot M,Duy KT,Docquier PL.3D-corrective osteotomy using surgical guides for posttraumatic distal humeral deformity[J].Acta Orthop Belg,2012,78(3):538-542.
• [7]孟国林,刘建,胡蕴玉,等.快速成型模型在制定胫骨平台复杂骨折手术方案中的指导作用[J].中华创伤骨科杂志,2011,13(12):1135-1138.
• [8]黄若昆,谢呜,余嘉,等.应用数字化技术设计胫骨远端后侧解剖钢板的研究[J].中华创伤骨科杂志,2013,15(10):889-892.
• [9]Omori S,Murase T,Kataoka T,et al.Three dimensional corrective osteotomy using a patient-specific osteotomy guide and bone plate based on a computer simulation system:accuracy analysis in a cadaver study[J].Int J Med Robot,2014,10(2):196-202.
• [10]赵烽,熊鹰,张仲子,等.桥接组合式内固定治疗股骨骨折的效果及生物力学特征[J].中国组织工程研究,2014,18(13):2217-2132.
• [11]Gangopadhyay S,Riley ND,Sivaji CK.Expanding nail or expanding femur?An adverse event with the expandable intramedullary nail[J].Acta Orthop Traumatol Turc,2010,44(2):166-168.2090
• [12]Mazzoni S,Marchetti C,Sgarzani R,et al.Prosthetically guided maxillofacial surgery:evaluation of the accuracy of a surgical guide and custom-made bone plate in oncology patients after mandibular reconstruction[J].Plast Reconstr Surg,2013,131(6):1376-1385.
• [13]Takeyasu Y,Oka K,Miyake J,et al.Preoperative,computer simulation-based,three-dimensional corrective osteotomy for cubitus varus deformity with use of a custom-designed surgical device[J].JBone Joint Surg Am,2013,95(22):173.
• [14]Zhou Z,Buchanan F,Mitchell C,et al.Printability of calcium phosphate:calcium sulfate powders for the application of tissue engineered bone scaffolds using the 3D printing technique[J].Mater Sci Eng C Mater Biol Appl,2014,38(1):1-10.