南方医科大学学报

南方医科大学学报 ›› 2016, Vol. 36 ›› Issue (02): 220-.

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基于3D打印的腹直肌旁切口治疗骨盆骨折的临床疗效

曾参军，谭新宇，黄华军，黄伟奇，李涛，金大地，张国栋，黄文华   

  • 出版日期:2016-02-20 发布日期:2016-02-20

Clincial effect of 3D printing-assisted minimal invasive surgery through a small incision lateral to the rectus abdominis for pelvic fracture

  • Online:2016-02-20 Published:2016-02-20

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摘要： 目的探讨骨盆骨折患者术前采用3D打印仿真骨盆模型体外模拟手术后应用腹直肌旁切口钢板内固定治疗的临床疗
效。方法回顾性分析2013年9月~2015年6月适合于前内侧钢板内固定术的骨盆骨折患者资料50例，术前先将患者骨盆CT
薄层扫描数据用DICOM格式导入Mimics软件进行三维重建、虚拟复位骨折、虚拟内固定设计，采用3D技术打印出患者虚拟复
位后的仿真骨盆模型，并按照虚拟内固定设计方案进行钢板螺钉最佳位置设计、钢板预弯、螺钉长度测量、螺钉进入途径设计等
一系列术前模拟内固定，然后现实手术行腹直肌旁切口腹膜外间隙复位骨折、钢板内固定术。术后采用Matta标准评价骨折复位
情况，术后半年采用Majeed评分标准功能评定。结果采用Matta标准评价骨折复位情况优良率96%。采用Majeed评分标准
功能评定优良率为94%。术后影像评估内固定与术前模拟内固定基本一致，无1例螺钉进入髋关节腔。平均手术时间127 min。
平均术中出血量728 mL。平均手术切口长度8.4 cm。术后疼痛评分（VAS）：12例重度疼痛，28例中度疼痛，10例轻度疼痛。术
后可早期功能锻炼。所有患者均临床愈合，临床愈合时间平均8周。结论3D打印技术体外模拟内固定可使手术更加精准、安
全、完美。术前模拟内固定钢板预弯、螺钉数据测量缩短了手术时间。腹直肌旁切口具有微创特点，手术创伤小、切口小、出血
少、术后疼痛轻、术中暴露好、骨折复位好、可早期下地功能锻炼，临床愈合快，值得临床推广。

Abstract: Objective To evaluate the clinical effect of 3D printing-assisted minimal invasive surgery on pelvic fracture by plate
internal fixation through a small incision lateral to the rectus abdominis. Methods This retrospective study was conducted
among 50 patients with pelvic fracture undergoing anteromedial plate internal fixation between September, 2013 and June,
2015. Thin-layer computed tomography scan data of the patients were input into Mimics software in DICOM format for 3D
editing and virtual surgery before the operation. The pelvic model was created by 3D printing. Simulated operation was
performed to design the optimum location of the plate screw, prelflex of the plate, screw length measurement and screwing
approach. Diaplasis and internal fixation were performed through the extraperitoneal space with a small incision lateral to the
rectus abdominis. Matta standard was employed for diaplasis evaluation, and Majeed assessment was used for function
evaluation 6 months after the operation. Results According to Matta standard, excellent and good diaplases were achieved in
96% of the cases, as compared with 94% according to Majeed assessment. Radiographic examination showed a good
consistency between the internal fixation and simulated operation. No screw entry into the hip joint cavity occurred in these
cases. The mean operation time was 127 min in these cases with a mean intraoperative blood loss of 728 mL and a mean
incision length of 8.4 cm. Based on the postoperative VAS score, 12 patients reported severe pain, 28 reported moderate pain
and 10 reported mild pain. All the patients were advised for early functional exercise after the operation and clinical healing
was achieved in a mean of 8 weeks. Conclusions 3D printing with simulated operation can improve the accuracy and safety of
the operation. Preoperative simulation of plate preflex and screw length measurement can shorten the operation time. A small
incision lateral to the rectus abdominis allows minimally invasive operation for pelvic fractures.