3D打印体表导板引导踝部空心钉取出

3D printed guider on body surface for removing cannulated screw in ankle

摘要:

[目的] 介绍 3D 打印体表导板引导下踝部空心钉取出的手术技术和初步临床效果。[方法] 5 例患者采用上述技术取出踝部空心螺钉。术前在踝部体表贴 3 片环形的金属垫片用于定位锚点的作用，用记号笔在体表标记好环形垫片的位置，带着定位好垫片行 CT 扫描并 3D 重建，后将扫描数据导入 e3D 软件设计含定位孔和螺钉导针孔体表导板，术中将导板定位孔和体表标记垫片孔吻合后在导针孔置入导针并取出螺钉，术中 C 形臂 X 线机透视，评估此手术方法的安全性和有效性。[结果] 5 例患者 13 枚螺钉，4 例患者一次性置入导针成功，1 例患者 1 枚内踝空心螺钉首次置入导针失败，经调整导板位置后二次置入成功。每枚螺钉术口约 0.5 cm；从放置导板到取出螺钉时间(5.62±2.47)min，一次性置入导针成功率 92.30%，无神经、血管损伤等并发症。[结论]3D 打印体表导板引导下行踝部空心钉取出术成功率高，导板制备对材质要求不高，成本低廉。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical outcomes of 3D printed guider on body surface for removing cannulated screw at ankle. [Methods] A total of 5 patients underwent abovesaid procedure to remove cannulated screw in the an- kle. As 3 annular metal spacers were pasted on the body surface of the ankle before surgery to locate the anchor points, and the position of annular spacers was marked on the body surface with a marker pen, CT scan and 3D reconstruction were performed with the positioning spacers, and the scanning data were imported into e3D software to design a body-surface guider with positioning holes. Intraoperatively, the positioning hole of the guider was anastomosed with the marked gasket hole on the body surface, and then the guide wire was inserted into the guider hole, finally, the screw was removed. Intraoperatively, C-arm fluoroscopy was used to evaluate the safety and effectiveness of this surgical method. [Results] Of the 5 patients with 13 screws in total, 4 patients had guide wire placed successfully at one time, while the re- maining 1 patient failed to place the guide wire at the first time with an internal malleolus cannulated screw, and got successful placement at the second time after adjusting the position of the guider. The incision for each screw was about 0.5 cm with time from guider placement to removal of screw of (5.62±2.47) min, the first time success rate of 92.30%, without neurovascular injury and other complications. [Conclusion] This 3D printed guider on body surface has a high success chance to remove cannulated screw in the ankle, additionally, the prepa- ration of guide plate has low material requirements with low cost.