眼眶爆裂性骨折修复手术模拟的眼眶3D打印模型和外科种植体模型的研究

摘要

目的 设计并制作可用于眼眶爆裂性骨折修复手术临床与教学的3D眼眶模型.方法 选取2016年11月至2017年2月在山东文登整骨医院眼科确诊的10例(10眼)眼眶下壁爆裂性骨折患者眼眶CT检查DICOM格式的原始CT数据.使用Mimics软件对二维CT图像依次进行阈值选取、区域增长、处理模具、多层编辑修饰等过程,最终获得完整的眼眶爆裂性骨折3D模型,通过3D打印机打印出患者的3D眼眶模型,测量各模型的具体大小,分别将模型与患者的眼眶解剖标志测量数据进行配对t检验.由高年资眼眶外科医师对打印的眼眶爆裂性骨折模型和外科种植体模型进行模拟手术操作.结果 共有10例眼眶下壁爆裂性骨折患者,其中男5例(5眼)、女5例(5眼).3D模型和外科种植体模型成功设计并打印.全部男性组和女性组眼眶爆裂性骨折3D打印模型与CT测量的眼眶数据基本相吻合,差异均无统计学意义(均为P＞0.05).由高年资眼眶外科医师在模拟手术室手术环境下向住院医师示范眼眶骨折修复术手术操作,3D打印的眼眶爆裂性骨折模型可成功用于模拟手术操作和教学示范.结论 3D打印的眼眶爆裂性骨折模型能够真实还原患者眼眶损伤情况和眼眶解剖细节,为医师提供了立体直观的术前设计的模型,对了解眼眶爆裂性骨折的波及范围和手术教学模拟具有积极意义.%Objective To explore the possibility of three-dimensional orbit replications for clinic and teaching of orbital blowout fracture surgical operation.Methods The orbital CT DICOM format data from 10 patients with orbital floor fractures were selected between November 2016 and January 2017 from Wendeng Osteopath Hospital.Thresholding technique,region growing technique,edit mask technique and multiple slice edit technique were used in sequence by Mimics software.And 3D replications were printed by Object 500 3D printer.The sizes of the replications were measured.The model of orbital blowout fracture and surgical implant model were simulated by senior orbital surgeon.Results In the 10 cases,male was 5 cases,and female was 5 eyes.The 3 D replications of the orbits were successfully designed and printed.The sizes of the 3D replications were basically consistent with those of patients' orbits,and there was no statistical difference (all P ＞ O.05).Under operation room surgery simulation environment,the orbital fracture surgical repair operation was demonstrated to the resident by the senior surgeon,3D printing orbital blowout fracture model can be successfully used to simulate the operation and teaching demonstration.Conclusion 3D printing orbital blowout fracture model can restore the true orbital injury and orbital anatomic details,provides the design operation of stereoscopic model for the physician,which has positive significance to understand the scope and surgery teaching simulation of orbital blowout fracture.