打印与虚拟手术设计在髋臼骨折手术治疗中的应用

目的 从基础与临床两方面探讨3D打印与虚拟手术设计在髋臼骨折手术治疗中的应用可行性。 方法 基础部分选择36例髋臼骨折病人，临床部分选择13例髋臼骨折病人，应用3D打印技术结合术前虚拟手术设计，根据髋臼骨折病人骨盆薄层CT扫描数据进行三维重建、虚拟骨折块分离、虚拟手术复位、虚拟内固定植入模拟髋臼骨折手术，为病人制定个性化的手术方案，进行临床手术治疗。 结果根据病人骨盆薄层CT扫描数据成功获得高精度虚拟复位模型，虚拟模拟骨折块分离、复位、内固定置入等步骤确定钢板植入位置、螺钉植入方向、螺钉植入长度，制定个性化、最优化手术方案设计，并结合虚拟手术设计完成3D模拟手术；基础实验部分病人钢板位置均与数字化设计高度一致，螺钉方向与数字化设计高度吻合，虚拟手术设计螺钉长度与3D模拟手术螺钉长度比较差异无统计学医院(P>0.05)；临床实验部分病人均按照虚拟手术设计成功完成手术，术后与虚拟手术设计钢板、螺钉位置及数量高度一致，虚拟手术设计螺钉长度与临床手术螺钉长度比较差异无统计学意义(P>0.05)。 结论 3D打印与虚拟手术设计可为髋臼骨折病人制定最优化、个性化的手术方案，有效提高手术精确性与安全性，应用可行性高。

Application value of printing and virtual surgery design in the treatment of acetabular fracture

Objective To explore the application feasibility of 3D printing and virtual surgery design in the treatment of acetabular fractures from both basic and clinical aspects. MethodsThirty-six patients with acetabular fractures were selected in the basic part, and 13 patients with acetabular fractures were selected in the clinical part.The 3D printing combined with preoperative virtual surgery design was applied.The three-dimensional reconstruction, virtual fracture fragments separation, virtual surgical reduction and virtual internal fixation implantation were performed according to pelvic thin-slice CT scan data of acetabular fracture patients to simulate acetabular fracture surgery for developing a personalized surgical plan for patients to conduct clinical surgical treatment. Results A high-precision virtual reduction model was successfully obtained according to the patient′s pelvic thin-slice CT scan data.The fracture block separation, reduction, internal fixation implantation and other steps were virtually simulated to determine the plate placement position, screw implantation direction and screw implantation length.The individualized and optimized surgical program were drawn up, the 3D simulation surgery was completed by combining with virtual surgery design.In the basic experimental part, the patient′s steel plate position and screw direction were highly consistent with the digital design.The difference of the screw length between virtual surgery design and 3D simulation surgery was not statistically significant(P>0.05).In the clinical experiment, the operations in some patients were successfully completed according to the virtual surgery design, the positions and quantities of the plates and screws were highly consistent with the virtual surgery design, and the difference in the length of screw between the virtual surgery design and clinical operation was not statistically significant(P>0.05). ConclusionsThe 3D printing and virtual surgery design can provide the optimal and personalized surgical solutions for patients with acetabular fractures, which can effectively improve the accuracy and safety of surgery, the application feasibility is high.