中国修复重建外科杂志

中国修复重建外科杂志

3-D 打印导航模板辅助肘关节肿瘤切除及个性化肘关节置换术的初步应用

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目的 探讨 3-D 打印导航模板辅助肘关节肿瘤切除并为患者定制个性化肘关节假体成功实施肘关节置换术的临床方法。 方法 2016 年 8 月收治 1 例 63 岁左肱骨远端肿瘤男性患者。因发现左肱骨远端巨大包块 3 个月余,伴肘关节疼痛、活动受限入院。术前采用计算机辅助设计联合 3-D 打印技术,模拟肿瘤切除范围,定制肿瘤切除模板以及用于修复肿瘤切除后骨缺损的同种异体骨修剪模板,同时设计个性化肘关节假体。术中按照设计精确切除肿瘤并行肘关节重建术。 结果 该例患者手术顺利完成,术中肿瘤切除时间 46 min,安装个性化肘关节假体与同种异体骨时间 95 min;术中无需透视。术后 1 周行 X 线片及 CT 检查,示肘关节假体位置良好,尺骨假体前倾角为 30°,肘关节提携角为 15°,与术前模拟肘关节置换术效果一致。术后 1 个月手指屈伸活动正常,肘关节屈伸活动范围为 0~130°,前臂旋前 80°、旋后 80°。术后 7 个月肘关节活动满足日常生活需要。肿瘤无复发、转移。 结论 对于肘关节保肢术,采用计算机辅助技术可实现术前模拟手术效果,通过制备导航模板提高了手术精准度,定制个性化肘关节假体成功为患者实施了肘关节置换术从而重建肘关节功能,且具有术中无需 X 线透视、 缩短手术时间等优点。

Objective To explore the clinical methods of resection of elbow tumor and total elbow replacement with custom personalized prosthesis based on three dimensional (3-D) printing navigation template. Methods In August 2016, a 63-year-old male patient with left elbow joint tumor was treated, with the discovery of the left distal humerus huge mass over 3 months, with elbow pain, activity limitation of admission. Computer-assisted reduction technique combined with 3-D printing was used to simulate preoperative tumor resection, a customized personal prosthesis was developed; tumor was accurately excised during operation, and the clinical result was evaluated after operation. Results The time was 46 minutes for tumor resection, and was 95 minutes for personalized implant and allograft bone without fluoroscopy. X-ray and CT examination at 1 week after operation showed good position of artificial elbow joint; the anteversion of ulna prosthesis was 30° and the elbow carrying angle was 15°, which were consistent with the simulated results before surgery. The finger flexion was normal at 1 month after operation; the range of motion was 0-130° for elbow flexion and extension, 80° for forearm pronation, and 80° for forearm supination. The elbow function was able to meet the needs of daily life at 7 months after operation, and no recurrence and metastasis of tumor were observed. Conclusion For limb salvage of elbow joint, computer aided design can make preoperative surgical simulation; the navigation template can improve surgical precision; and the function of elbow joint can be reconstructed with customized and personlized prosthesis for total elbow replacement.

关键词: 人工肘关节置换术; 肘关节假体; 3-D 打印技术; 计算机辅助设计; 骨肿瘤

Key words: Total elbow replacement; elbow prosthesis; three-dimensional printing technology; computer aided design; bone tumor

引用本文: 苗秋菊, 丁焕文, 黄敏强, 沈健坚, 涂强, 黄淼俊. 3-D 打印导航模板辅助肘关节肿瘤切除及个性化肘关节置换术的初步应用. 中国修复重建外科杂志, 2017, 31(4): 385-391. doi: 10.7507/1002-1892.201611091 复制

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