3D打印技术在拇指再造手术中的应用  

The application of three-dimesional technique in the thumb reconstruction

作　　者：张德洪 史洪成 易类 王允 苏国柱 李扬斯 ZHANG De-hong;SHI Hong-cheng;YI Lei;WANG Yun;SU Guo-zhu;LI Yang-si(Dept of Repair and Reconstruction Microsurgery,Yunnan Sino-German Orthopaedic Hospital,Kunming,Yunnan 650000,China;不详)

机构地区：[1]云南中德骨科医院修复重建显微外科,云南昆明650000 [2]长春骨伤医院手足显微外科,吉林长春130000

出　　处：《临床骨科杂志》2022年第3期385-388,共4页Journal of Clinical Orthopaedics

摘　　要：目的探讨3D打印技术在拇指再造手术中的应用价值。方法采用3D打印技术指导拇指再造手术修复11例拇指缺损患者,其中9例切取拇甲瓣与第二趾组合移植拇指再造,2例离断指足部异位寄养二期回植再造拇指。术前患者双手及足部行CT扫描,根据3D打印模型进行手术方案设计。结果患者均获得随访,时间6~12个月。再造拇指均成活。术后6个月再造指长度、周径及甲廓形态基本与正常指体一致,指端感觉功能S39指,S3;2指。1例Ⅵ度缺损术后出现虎口挛缩,经再次Z字成形虎口开大手术修复。术后6个月按照中华医学会手外科学会上肢部分功能评定试用标准评定功能:优7例,良4例。结论结合3D打印技术对拇指缺损患者进行拇指再造,术前可精细化设计,提高拇指再造精准性,术后效果良好。Objective To explore the application value of three-dimesional(3D)printing technique in thumb reconstruction.Methods The 11 patients with thumb defects were repaired by thumb reconstruction guided by 3D printing tcchnique.Among them,9 patients were reconstructed by combined transplantation of the cut thumb flap with the second toe;in 2 cases,the amputated fingers were fostered in ectopic position of foot,which were re-implanted for thumb reconstruction in the second stage.The patients’hands and feet were scanned with CT before surgery,and the surgical plan was designed according to the 3D printing model.Results All patients were followed up for 6~12 months.All the reconstructed thumbs survived.At 6 months after the operation,the length,circumference and nail shape of the reconstructed finger were basically same as those of the normal finger.The sensory function of the finger tip was S3 in9 fingers and S3;in 2 fingers.One case with degreeⅥdefect had tiger mouth contracture after operation,which was repaired by Z-shaped tiger mouth enlargement surgery again.At 6 months after the operation,the function was evaluated according to the trial standard of upper limb function evaluation of Chinese Medical Association Hand Surgery Society:excellent in 7 cases,good in 4 cases.Conclusions Combined with 3D printing technique for thumb reconstruction in patients with thumb defect,the preoperative fine design can improve the accuracy of thumb reconstruction,and the postoperative effect is good.

关 键 词：3D打印 拇指再造 显微外科技术 

分 类 号：R658.1[医药卫生—外科学] R319[医药卫生—临床医学]