中国修复重建外科杂志

中国修复重建外科杂志

3D 打印技术在严重肱骨远端骨缺损治疗中的应用观察

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目的 探讨 3D 打印技术在严重肱骨远端骨缺损精准化、个性化手术治疗中的应用。 方法 2010 年 12 月—2015 年 12 月采用 3D 打印技术个性化定制关节假体治疗 5 例严重肱骨远端骨缺损患者。其中男 4 例,女 1 例;年龄 23~57 岁,平均 35 岁。骨缺损长度 5~12 cm,平均 8 cm。致伤原因:机械砸伤 2 例,绞伤 3 例。均为 Gustilo Ⅲ型。合并桡骨骨折 2 例,尺神经损伤 1 例,桡神经损伤 3 例。受伤至一期手术时间为 6~18 h,平均 10 h。记录手术时间、术中失血量、术中透视次数。术后定期随访,摄肘关节正侧位 X 线片明确有无假体松动;采用 Mayo 肘关节功能评分标准(MEPS)评分及上肢 Enneking 评分评价患肢功能。 结果 患者手术时间 140~190 min,平均 165 min;术中出血量 310~490 mL,平均 415 mL;透视次数 1~3 次,平均 1.6 次。术后 5 例患者均获随访,随访时间 14~38 个月,平均 21 个月。1 例出现切口渗液,经抗炎局部换药处理后痊愈;1 例出现皮下血肿,在彩超引导下穿刺引流后好转。术后各时间点 MEPS 评分及 Enneking 评分均较术前显著改善,差异有统计学意义(P<0.05)。除术后 6、12 个月间 MEPS 评分比较差异无统计学意义(P>0.05)外,其余各时间点 MEPS 评分及 Enneking 评分比较差异均有统计学意义(P<0.05)。随访期间均未发生假体松动、关节脱位等并发症。 结论 3D 打印技术可以实现严重肱骨远端骨缺损的个性化治疗,可以获得相对较好的肘关节功能,术后并发症少。

Objective To explore the application of three-dimensional (3D) printing technology in precise and individualized surgical treatment of severe distal humeral bone defect. Methods Five patients with severe distal humeral bone defects were treated with customized 3D printing prosthesis between December 2010 and December 2015. There were 4 males and 1 female, with an age of 23-57 years (mean, 35 years); and the length of the bone defect was 5-12 cm (mean, 8 cm). The cause of injury was mechanical injury in 2 cases and strangulation in 3 cases. All of them were the open fracture of Gustilo type Ⅲ. There were 2 cases of radial fracture, 1 case of cubital nerve injury, and 3 cases of radial nerve injury. The time from injury to one-stage operation was 6-18 hours (mean, 10 hours). The operation time, intraoperative blood loss, and intraoperative fluoroscopy were recorded. During follow-up, the anteroposterior and lateral X-ray films of the elbow joints were performed to identify whether there was prosthesis loosening; Mayo Elbow Performance Score (MEPS) and upper extremity Enneking score were used to evaluate limb function. Results The operation time was 140-190 minutes (mean, 165 minutes). The intraoperative blood loss was 310-490 mL (mean, 415 mL). The intraoperative fluoroscopy was 1-3 times (mean, 1.6 times). Five patients were followed up 14-38 months (mean, 21 months). The wound exudate occurred in 1 case and cured after anti-inflammatory local dressing change; the subcutaneous hematoma occurred in 1 case, and improved after color Doppler ultrasound guided puncture and drainage. The MEPS scores and the Enneking scores were all significantly improved when compared with preoperative ones (P<0.05). Except for MEPS score between 6 and 12 months after operation had no significant difference (P>0.05), there were significant differences in MEPS scores and Enneking scores between the other time points (P<0.05). During the follow-up, no prosthetic loosening or joint dislocation occurred. Conclusion 3D printing technology can achieve personalized treatment of severe distal humeral bone defects, obtain relatively good elbow joint function, and has less postoperative complications and satisfactory effectiveness.

关键词: 肱骨远端骨缺损; 3D 打印技术; 个性化定制; 关节置换

Key words: Distal humeral bone defect; three-dimensional printing technology; personalized customization; arthroplasty

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