Zheng Pengfei, Yao Qingqiang, Xu Peng, Wang Liming
Department of Pediatric Orthopaedics, Children's Hospital, Nanjing Medical University, Nanjing, 210008, Jiangsu, China.
Digital Medicine Institute, Nanjing Medical University, Nanjing, 210006, Jiangsu, China.
Int J Comput Assist Radiol Surg. 2017 May;12(5):865-871. doi: 10.1007/s11548-017-1535-3. Epub 2017 Feb 11.
To investigate the feasibility and accuracy of a drill template based on computer-aided design (CAD) and 3D printing technology for the placement of screws in Locking Compression Pediatric Hip Plate (LCP-PHP).
LCP-PHP was used in 11 children [5 with femoral neck fracture and 6 with development dysplasia of hip (DDH)]. Using the CT data, the proximal femur model was created by a 3D printer. Fracture reduction and the placement of the screw in the femoral neck and the LCP-PHP were simulated by the computer. The navigation template was designed by the software to match the proximal femur. After the feasibility of the 3D model operation was demonstrated before the operation, the guide pins and the screws were inserted with the help of the navigate template in the operation.
During surgery, the navigation template for each case was matched to the bony markers of the proximal femur. With the help of the template, in femoral neck fracture cases, three screws could be accurately inserted into the femoral neck to implant the LCP-PHP and stabilize the fracture. The template for DDH includes all operation parameters and steps for proximal femoral varus rotation and shortening osteotomy, which made the surgery much easier to perform. Radiographs taken after surgery showed that the postoperative results closely corresponded to the preoperative computer simulation. The average time taken for LCP-PHP placement was 26.5 min; radiography was used during surgery only for an average of 6.0 times. Postoperative radiographs showed good results.
With the use of CAD and 3D printing technology, accurate placement of individualized navigation template of LCP-PHP can be achieved. This technology can reduce intraoperative damage to the femoral neck epiphysis, decrease operation time, reduce intraoperative hemorrhage, and decrease radiation exposure to patients and personnel during the surgery.
探讨基于计算机辅助设计（CAD）和3D打印技术的钻孔模板用于锁定加压小儿髋钢板（LCP-PHP）螺钉置入的可行性及准确性。
11例儿童使用LCP-PHP[5例股骨颈骨折，6例发育性髋关节发育不良（DDH）]。利用CT数据，通过3D打印机创建股骨近端模型。计算机模拟骨折复位及股骨颈和LCP-PHP螺钉置入。软件设计导航模板以匹配股骨近端。术前证实3D模型操作可行后，术中借助导航模板插入导针和螺钉。
手术过程中，每个病例的导航模板均与股骨近端的骨性标志匹配。借助模板，在股骨颈骨折病例中，可将3枚螺钉准确插入股骨颈以植入LCP-PHP并稳定骨折。DDH的模板包含股骨近端内翻旋转和缩短截骨的所有手术参数及步骤，使手术操作更简便。术后X线片显示术后结果与术前计算机模拟结果密切相符。LCP-PHP置入平均用时26.5分钟；术中平均仅使用X线透视6.0次。术后X线片显示效果良好。
使用CAD和3D打印技术，可实现LCP-PHP个体化导航模板的精准置入。该技术可减少术中对股骨颈骨骺的损伤，缩短手术时间，减少术中出血，并减少手术过程中患者和工作人员的辐射暴露。
