数字化和3D打印技术辅助治疗陈旧性髌骨骨折

目的探讨数字化和3D打印技术辅助陈旧性髌骨骨折精确截骨、复位和内固定方法,了解其在辅助治疗陈旧性髌骨骨折中的价值。方法自2006年以来,纳入5例陈旧性髌骨骨折畸形愈合患者采用CT薄层扫描、三维重建获得骨折部位骨关节三维模型,采用计算机辅助分析骨折移位和新生骨痂形成情况,CAD设计辅助手术模板引导骨折面准确截骨、精确复位,仿真模拟骨折复位、内固定过程,最后采用膝关节HSS评分标准评定术前、术后2周、末次随访时的膝关节功能。结果5例患者经14~23个月的随访,随访期间未发现螺钉、钢缆滑脱松动以及伤口感染等并发症,术后X线片证实骨折均解剖复位;根据膝关节HSS评分标准评价,术前HSS评分为47、53、35、40、42分,术后2周HSS评分为82、83、80、85、86分,末次随访HSS评分为95、86、89、90、91分。最后根据膝关节HSS评分标准评价:优5例。结论采用计算机辅助精确界定髌骨骨折面、模拟骨折复位内固定、个性化手术模板引导精确截骨、复位和内固定过程,解决了陈旧性髌骨骨折截骨部位确定困难、复位欠佳等问题。

Clinical application of digital and 3D printing in treating old patella fracture

Objective To discuss the new method of computer-aided design(CAD) and 3 D printing technology in accurate reduction and fixed of old patella fracture, and to understand it’s value in the treatment of old transverse patella fracture.Methods Since 2006, Five patients with old patellar fracture malunion obtained knee 3 D model by CT thin layer scanning and 3 D reconstruction. The fracture displacement and bone callus formation were analyzed with computer aided technique.CAD-based surgical template lead the whole precision surgery(including osteotomy, reposition and fixation). The hospital for special surgery knee score(HSS) was used to evaluate the preoperative, 2 weeks postoperative and the last follow-up functions of the knee joint. Results Five patients were followed up for 14-23 months. There were no complications such as screws loosening, wirerope slipping and infection during the follow-up period. All patients were confirmed to be anatomical reattachment by X-ray. According to the knee score(HSS) standard evaluation, the preoperative for HSS score: 47, 53, 35, 40, 42 points, 2 weeks postoperative HSS score: 82, 83, 80, 85, 86 points, the last follow-up HSS score: 95, 86,89, 90, 91 points. According to knee score(HSS): excellent in 5 cases among 5 patients. Conclusion Using computer-aided precise definition of patella fracture surface, simulated fracture fixation, individualized surgical template to guide the process of fracture fixation, the old patella fracture fixation to enhance the digital level, with a more accurate and reliable treatment.