3D打印颅骨保护帽在创伤性颅骨缺损患者中的应用

doi:10.3877/cma.j.issn.2095-9141.2026.02.007

目的

探讨3D打印颅骨保护帽在创伤性颅骨缺损患者中的应用效果。

方法

回顾性分析安徽医科大学第一附属医院神经外科自2023年12月至2025年10月收治的31例创伤性颅脑损伤（TBI）后行去骨瓣减压术（DC）患者的临床资料，根据术后是否佩戴3D打印保护帽分为佩戴组（15例）和对照组（16例）。术后随访3个月，观察并比较2组患者硬膜下积液发生率、并发症及预后情况。

结果

随访期间，14例患者术后出现硬膜下积液，其中佩戴组1例（6.7%），对照组13例（81.3%）。2组患者的硬膜下积液发生率及最大厚度比较，差异均有统计学意义（P<0.05）；2组患者均未出现皮肤过敏、破损、切口愈合不良等不良事件。佩戴组术后3个月的格拉斯哥预后扩展量表评分显著高于对照组，差异有统计学意义（P<0.05）。

结论

3D打印保护帽可减少TBI患者DC后硬膜下积液发生风险，改善患者预后。

关键词: 3D打印, 创伤性颅脑损伤, 去骨瓣减压术, 颅骨缺损, 硬膜下积液

Objective

To investigate the application efficacy of 3D-printed protective caps in patients with traumatic skull defects.

Methods

A retrospective analysis was conducted on the clinical data of 31 patients with traumatic brain injury (TBI) who underwent decompressive craniectomy (DC) in the Neurosurgery Department of the First Affiliated Hospital of Anhui Medical University from December 2023 to October 2025. The patients were divided into a cap-wearing group (15 cases) and a control group (16 cases) based on whether they wore 3D printed protective caps after surgery. Follow up for 3 months after surgery, observe and compare the incidence of subdural fluid accumulation, complications, and prognosis between the two groups of patients.

Results

During the follow-up period, 14 patients developed subdural fluid accumulation after surgery, including 1 case (6.7%) in the cap-wearing group and 13 cases (81.3%) in the control group. The incidence of subdural effusion and the maximum thickness of subdural effusion were compared between the two groups of patients, and the differences were statistically significant (P<0.05); Both groups of patients did not experience adverse events such as skin allergies, damage, or poor wound healing. The Glasgow outcome scale-extended of the cap-wearing group at 3 months after surgery was significantly higher than that of the control group, and the difference was statistically significant (P<0.05).

Conclusions

The 3D-printed protective cap can reduce the risk of subdural effusion after DC in patients with TBI, and improve patient prognosis.

Key words: 3D printing, Traumatic brain injury, Decompressive craniectomy, Skull defect, Subdural effusion

图1 3D打印的聚乳酸保护帽示意图A：术后CT三维重建；B：软件构建3D打印保护帽；C：3D打印保护帽成品示意图；D：3D打印保护帽佩戴效果示意图

Fig.1 Schematic diagram of 3D-printed polylactic acid protective cap

表1 2组创伤性颅骨缺损患者一般资料比较

Tab.1 Comparison of general information between two groups of patients with traumatic skull defects

项目	佩戴组（n=15）	对照组（n=16）	t值	P值
性别[例（%）]				0.853
男	8（53.3）	8（50.0）
女	7（46.7）	8（50.0）
年龄（岁，±s）	52.93±14.74	55.93±14.96	0.563	0.578
颅骨缺损面积（cm²，±s）	60.49±13.22	60.17±11.05	0.072	0.943
术前GCS评分（分，±s）	9.00±2.61	9.00±3.03	0.450	0.656
血肿体积（mL，±s）	30.68±9.07	28.63±4.96	0.785	0.439
术前中线位移距离（mm，±s）	10.23±2.13	9.79±1.75	0.628	0.535

表1 2组创伤性颅骨缺损患者一般资料比较

Tab.1 Comparison of general information between two groups of patients with traumatic skull defects

项目	佩戴组（n=15）	对照组（n=16）	t值	P值
性别[例（%）]				0.853
男	8（53.3）	8（50.0）
女	7（46.7）	8（50.0）
年龄（岁，±s）	52.93±14.74	55.93±14.96	0.563	0.578
颅骨缺损面积（cm²，±s）	60.49±13.22	60.17±11.05	0.072	0.943
术前GCS评分（分，±s）	9.00±2.61	9.00±3.03	0.450	0.656
血肿体积（mL，±s）	30.68±9.07	28.63±4.96	0.785	0.439
术前中线位移距离（mm，±s）	10.23±2.13	9.79±1.75	0.628	0.535

图2 创伤性颅骨缺损患者3D打印颅骨保护帽佩戴前后的CT影像A：佩戴3D打印保护帽前；B：佩戴3D打印保护帽1周后；C：颅骨修补术后

Fig.2 CT images of a traumatic skull defect patient before and after wearing a 3D-printed skull protective cap

表2 测量者测量结果的可靠性分析

Tab.2 Reliability analysis of measurement results by measurers

分组	ICC（95%CI）
测量者内
测量者1.1 vs测量者1.2	0.939（0.604~0.970）
测量者2.1 vs测量者2.2	0.974（0.814~0.987）
测量者间
测量者1.1 vs测量者2.1	0.990（0.924~0.995）
测量者1.2 vs测量者2.2	0.966（0.761~0.983）
测量者1.1 vs测量者2.2	0.978（0.834~0.989）
测量者1.2 vs测量者2.1	0.948（0.655~0.975）

表2 测量者测量结果的可靠性分析

Tab.2 Reliability analysis of measurement results by measurers

分组	ICC（95%CI）
测量者内
测量者1.1 vs测量者1.2	0.939（0.604~0.970）
测量者2.1 vs测量者2.2	0.974（0.814~0.987）
测量者间
测量者1.1 vs测量者2.1	0.990（0.924~0.995）
测量者1.2 vs测量者2.2	0.966（0.761~0.983）
测量者1.1 vs测量者2.2	0.978（0.834~0.989）
测量者1.2 vs测量者2.1	0.948（0.655~0.975）

表3 2组创伤性颅骨缺损患者随访结果比较

Tab.3 Comparison of follow-up results between two groups of patients with traumatic skull defects

项目	佩戴组（n=15）	对照组（n=16）	t值	P值
硬膜下积液发生率[例（%）]	1（6.7）	13（81.3）		<0.001
硬膜下积液最大厚度（mm，±s）	3.31±1.28	6.89±1.78	6.390	<0.001
GOSE评分（分，±s）	5.73±1.33	4.56±0.81	2.971	0.006

表3 2组创伤性颅骨缺损患者随访结果比较

Tab.3 Comparison of follow-up results between two groups of patients with traumatic skull defects

项目	佩戴组（n=15）	对照组（n=16）	t值	P值
硬膜下积液发生率[例（%）]	1（6.7）	13（81.3）		<0.001
硬膜下积液最大厚度（mm，±s）	3.31±1.28	6.89±1.78	6.390	<0.001
GOSE评分（分，±s）	5.73±1.33	4.56±0.81	2.971	0.006

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Application of 3D-printed skull protective cap in patients with traumatic skull defects

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Application of 3D-printed skull protective cap in patients with traumatic skull defects