Peking University Shenzhen Hospital, Shenzhen, 518036, China.
Curr Med Sci. 2019 Dec;39(6):990-996. doi: 10.1007/s11596-019-2133-0. Epub 2019 Dec 16.
This study explored the feasibility of employing computer-aided design (CAD) and 3 dimensional (3D)-printed personalized guide plate for the mini-invasive percutaneous internal screw fixation of fractured scaphoid. The study consisted of two parts: (1) experimentation on upper limbs from corpses and (2) preliminary clinical application. Corpse experiments involved upper limbs of 6 adult corpses. The specimens of upper limbs were subjected to plain CT scan. Then the CT data were input into computer to conduct 3D reconstruction of wrist region. The direction and depth of the guide wire and screw were designed on the basis of the principle that screw should lie at the center of scaphoid and the long axis of the screw should be aligned with that of the scaphoid. The carpal bone model and the guide plate were designed and 3D-printed. By using the guide plates, the guide wire was placed and the cannulated compression screw was inserted. The wrist region was examined by X-ray and CT to observe the location of the screw in the scaphoid. The scaphoid was longitudinally excised to grossly observe the location and evaluate the result of screw insertion. For clinical application, the guide plate was employed in 4 patients with fresh scaphoid fracture using the aforementioned operative technique. Our results showed that, in the 6 corpse limbs, the guide plate well fitted the skin surface and the guide wire and screw were accurately put in place in one session. X-ray examination and gross observation confirmed that the screw was satisfactorily positioned and the result met the requirements of the preoperative design. For 4 patients, the guide wire and screw were all precisely inserted into place in one session. The operation time and X-ray exposure times were apparently reduced. The imaging examination exhibited satisfactory results and the hand functioned well. It was concluded that the operative guide plate used for the mini-invasive percutaneous internal screw fixation of fractured scaphoid not only can assist in accurate placement of screw but also shorten operation time and reduce insertion and X-ray exposure times, thereby reducing the radiation injury and damage to the substance and the blood circulation of carpal bone. Its use can also improve the learning curve of surgeons.
本研究探讨了计算机辅助设计（CAD）和 3 维（3D）打印个性化导向板在微创经皮内固定腕舟骨骨折中的应用可行性。研究分为两部分：（1）尸体上肢实验，（2）初步临床应用。尸体实验涉及 6 具成人尸体上肢。对标本进行上肢普通 CT 扫描。然后将 CT 数据输入计算机，对手腕区域进行 3D 重建。根据螺钉应位于舟骨中心、螺钉长轴应与舟骨长轴一致的原则，设计导丝和螺钉的方向和深度。设计并 3D 打印腕骨模型和导向板。使用导向板放置导丝并插入空心加压螺钉。通过 X 射线和 CT 检查腕关节，观察螺钉在舟骨中的位置。将舟骨纵向切除，大体观察螺钉的位置，并评价螺钉插入的结果。对于临床应用，采用上述手术技术，在 4 例新鲜舟骨骨折患者中使用导向板。我们的结果表明，在 6 具尸体上肢中，导向板与皮肤表面贴合良好，导丝和螺钉一次准确放置。X 射线检查和大体观察证实，螺钉位置满意，结果符合术前设计要求。对于 4 例患者，导丝和螺钉均一次准确插入。手术时间和 X 射线暴露时间明显减少。影像学检查结果满意，手部功能良好。结论：用于微创经皮内固定腕舟骨骨折的手术导向板不仅可以辅助螺钉准确放置，还可以缩短手术时间，减少插入和 X 射线暴露时间，从而减少辐射损伤和对腕骨实质和血液循环的破坏。它的使用还可以提高外科医生的学习曲线。
