中国修复重建外科杂志

中国修复重建外科杂志

3D 打印距骨部件修复重建距骨病损的生物力学研究

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目的通过生物力学试验,探讨 3D 打印距骨部件修复重建距骨病损的可行性。方法取 6 具新鲜冰冻踝关节尸体标本,行 CT 扫描三维重建,3D 打印制备距骨部件及截骨导板。首先,将标本固定于电子万能材料试验机,于踝关节中立位、背伸 10° 位及跖屈 14° 位分别施加 1 500 N 应力,测算距骨受力面积以及所受压强。然后标本行距骨截骨并植入 3D 打印距骨部件,再次进行生物力学测试。结果距骨部件植入前,踝关节背伸 10° 位时距骨受力面积最大,其次为中立位时,跖屈 14° 位时最小,组间比较差异有统计学意义(P<0.05);跖屈 14° 位时距骨所受压强最大,其次为中立位时,背伸 10° 位时最小,组间比较差异有统计学意义(P<0.05)。同一体位距骨假体植入前后距骨受力面积以及所受压强比较,差异均无统计学意义(P>0.05)。不同体位时,假体部分所受压强与距骨所受压强比较,差异无统计学意义(P>0.05)。结论大范围距骨病灶清除后可使用 3D 打印距骨部件进行精确修复重建,修复处局部所受压强无明显变化,提示其临床应用的可行性。

ObjectiveTo explore the feasibility of the repair and reconstruction of large talar lesions with three-dimensional (3D) printed talar components by biomechanical test.MethodsSix cadaveric ankle specimens were used in this study and taken CT scan and reconstruction. Then, 3D printed talar component and osteotomy guide plate were designed and made. After the specimen was fixed on an Instron mechanical testing machine, a vertical pressure of 1 500 N was applied to the ankle when it was in different positions (neutral, 10° of dorsiflexion, and 14° of plantar flexion). The pressure-bearing area and pressure were measured and calculated. Then osteotomy on specimen was performed and 3D printed talar components were implanted. And the biomechanical test was performed again to compare the changes in pressure-bearing area and pressure.ResultsBefore the talar component implantation, the pressure-bearing area of the talus varied with the ankle position in the following order: 10° of dorsiflexion > neutral position > 14° of plantar flexion, showing significant differences between positions ( P<0.05). The pressure exerted on the talus varied in the following order: 10° of dorsiflexion < neutral position < 14° of plantar flexion, showing significant differences between positions (P<0.05). The pressure-bearing area and pressure were not significantly different between before and after talar component implantations in the same position (P>0.05). The pressure on the 3D printed talar component was not significantly different from the overall pressure on the talus (P>0.05).ConclusionApplication of the 3D printed talar component can achieve precise repair and reconstruction of the large talar lesion. The pressure on the repaired site don’t change after operation, indicating the clinical feasibility of this approach.

关键词: 3D 打印技术; 距骨病损; 关节内应力; 修复重建; 生物力学

Key words: Three-dimensional printing technology; talar lesion; intra-articular pressure; repair and reconstruction; biomechanics

引用本文: 王碧菠, 陈博, 李星辰, 徐阳, 彭志杰, 徐向阳. 3D 打印距骨部件修复重建距骨病损的生物力学研究. 中国修复重建外科杂志, 2018, 32(3): 306-310. doi: 10.7507/1002-1892.201705068 复制

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