数字化设计结合3D打印技术精准治疗复杂肩胛骨骨折的应用研究

目的探讨应用数字化设计结合3D打印骨骼模型的个体化、精确化的手术治疗方案应用于复杂肩胛骨骨折患者的临床疗效。方法对东莞市石排医院骨科2018年6月至2020年6月40例复杂肩胛骨骨折患者进行随机分组。其中，试验组20例，肩关节螺旋CT扫描，将所得DICOM格式数据导入Mimics 15.0软件重建复杂肩胛骨骨折三维模型，并对相应骨折块进行模拟平移、旋转等操作，将骨折端进行虚拟复位。应用3D打印技术获得患者复位后的肩胛骨骨折模型。根据模型进行术前规划，塑形钢板后进行手术治疗。对照组20例，采用传统切开复位内固定方式进行治疗。记录手术中相关数据，术后复查X光线及CT，与术前设计相比对，采用Hardegger肩关节功能评分评定疗效。结果全部病例均获得5 ～ 13个月的随访，试验组手术时间与术中出血量均较对照组更少，差异有统计学意义（P<0.05）。两组骨折愈合时间差异无统计学意义（P>0.05）。末次随访，试验组优良率95%（19/20），对照组优良率为65%（13/20），两组临床效果对比，差异有统计学意义（P<0.05）。结论应用数字化设计结合3D打印技术，为复杂肩胛骨骨折患者制定治疗方案，可满足微创化、精确化、个体化的要求，继而可以有效减少手术创伤、缩短手术时间、降低手术操作难度，为患者更快、更好地恢复肩关节功能创造有利的条件。

英文摘要:

Objective To investigate the curative effect of the application of digital design and 3D printing technique for the individualized and accurate treatment in complex scapular fracture. Methods A total of 40 patients with complex scapular fracture in Dongguan Shipai Hospital during June 2018 to June 2020 were randomly grouped. The experimental group(20 patients) underwent spiral CT scan of shoulder joint.The data in DICOM format were imported into mimics 15.0 software to reconstruct the three-dimensional model of complex scapular fracture, and the corresponding fracture blocks were simulated to translate and rotate, and the fracture end was virtual reduced. The scapular fracture model after reduction was obtained by 3D printing technology. Preoperative planning was carried out according to the model, and surgical treatment was carried out after shaping the steel plate. Twenty cases in the control group were treated with traditional open reduction and internal fixation. The relevant data during the operation were recorded, and the X-ray and CT were rechecked after the operation. Compared with the preoperative design, the curative effect was evaluated by Hardegger shoulder function score. Results All cases were followed up for 5-13 months. The operation time and intraoperative bleeding in the experimental group were less than those in the control group (P<0.05). There was no significant difference in fracture healing time between the two groups (P>0.05). At the last follow-up, the excellent and good rate was 95% (19/20) in the experimental group and 65%(13/20) in the control group. There was significant difference between the two groups(P<0.05). Conclusion The application of digital design combined with 3D printing technology to formulate treatment plans for patients with complex scapular fractures can meet the requirements of minimally invasive, accurate and individualized, and then can effectively reduce surgical trauma, shorten surgical time and reduce the difficulty of surgical operation, so as to create favorable conditions for patients to recover shoulder joint function faster and better.

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