3D打印结合内固定模型库辅助复杂胫骨平台骨折精确化内固定手术

本研究旨在通过应用3D打印导航模板辅助复杂胫骨平台骨折内固定植入手术, 提高内固定手术的精确性. 采用5例正常膝关节尸体标本进行Schatzker V型骨折造模, 骨折模型进行CT扫描三维重建, 结合钢板模型库进行虚拟个性化内固定手术. 根据虚拟的优化内固定手术方案设计并3D打印个性化导航模板, 引导现实的骨折标本内固定手术. 通过虚拟术前规划(术前)和标本实验(术后)的螺钉长度、进钉点位置以及方向的对比分析来评估内固定效果, 结果提示本实验获得了优化、精确的内固定效果. 螺钉长度差异为(0.89±2.94)mm, p>0.05; x, y和z轴进钉点差异分别为(1.19±1.31), (1.73±1.31)和(1.22±0.88)mm, p>0.05; 冠状面(x-y)和横断面(x-z)的投影角差异分别为(2.99±2.98)°和(1.57±5.13)°, p>0.05. 以螺钉长度、进钉点位置和钉道投影角进行评估术前和术后的钉道差异, 结果提示二者无明显差异. 在钢板模型库和个性化导航模板的辅助下可以获得理想和精确的内固定植入方案, 提高个性化内固定手术的精确性和有效性

Precision surgery of complicated tibial plateau fracture assisted by 3D implant library and 3D-printed navigational template

This study is aimed to improve the precision of 3D-printed navigational template for plating and screwing procedures during surgery for complicated tibial plateau fracture. Five normal cadaveric knee specimens were scanned using computed tomography (CT) and reconstructed into volume models. Virtual Schatzker classification of V tibial plateau fractures were modeled based on the 3D models. The classifications were used to perform personalized preoperative planning of plating and screwing procedures assisted by the library of implant models. According to the optimal planning, patient-specific navigational templates were used to produce a 3D print in order to guide the real cadaveric surgical implantation. The analysis of fixation efficacy in terms of the deviations of screw placement between preoperative and postoperative screw trajectories were measured and compared. Furthermore, the screw lengths, entry point locations and screw directions can be precisely determined. With preoperative planning, optimized and precise fixation results were achieved in real cadaveric surgeries and clinical surgeries. In the cadaveric study, the deviations of screw length were (0.89±2.94) mm, p>0.05. The displacements of entry point in the x-, y-, and z-axis were (1.19±1.31), (1.73±1.31) and (1.22±0.88)mm, respectively, p>0.05. The deviations of projection angle in the coronal (x-y) and transverse (x-z) planes were (2.99±2.98)° and (1.57±5.13)°, respectively, p>0.05. The precision of screw placement with respected to deviations of screw length, entry point and projection angle between the ideal and actual screw trajectories revealed no significant difference. The ideal and precise preoperative planning of plating and screwing can be achieved in the real surgery assisted by the 3D models library of implants and the patient- specific navigational template. This technology improves the precision and efficiency of personalized internal fixation surgery