3D打印个体化假体用于上肢显微修复后骨和关节缺损精准重建的短期疗效  

Short term efficacy of 3D printed individualized prosthesis for precise reconstruction of bone and joint defects after upper limb microsurgical repair

作　　者：王剑利 王根 曲新强 张龙 孙圣亮 白赟 WANG Jianli;WANG Gen;QU Xinqiang;ZHANG Long;SUN Shengliang;BAI Yun(Institute of Orthopaedic Trauma of PLA,the 80th Group Army Hospital,Weifang,Shandong Province 261021,China)

机构地区：[1]第八十集团军医院全军创伤骨科研究所,山东潍坊261021

出　　处：《中华显微外科杂志》2023年第3期284-290,共7页Chinese Journal of Microsurgery

基　　金：国家自然科学基金(81902218);国家重点专科手外科中心军队建设项目,全军"十二五"计划重点课题(BJN13J001)。

摘　　要：目的观察3D个体化假体在治疗上肢显微修复后骨和关节缺损的治疗效果。方法2019年6月-2021年9月,回顾性分析第八十集团军医院全军创伤骨科研究所收治的上肢显微修复皮瓣覆盖后遗留骨和关节缺损患者12例,其中腕部不完全离断1例,手指、掌骨缺损2例,指骨间关节缺损4例,桡腕关节骨缺损4例,月骨缺损1例。其中软组织缺损面积1.5 cm×3.0 cm~12.0 cm×18.0 cm,骨缺损长度2.5~8.5(平均3.64)cm。对于不完全离断和完全离断肢体采取一期断肢(指)再植,二期行软组织修复,三期对遗留的骨和关节缺损采用3D打印个体化定制假体重建骨关节缺损。手指软组织缺损给予一期局部转移皮瓣覆盖,二期采用3D打印假体重建骨关节缺损。术后根据X线片结果,按照Paley骨折愈合评分标准判断骨和关节缺损断端与假体的骨整合情况。同时测量前臂及手部各关节的总主动活动度(TAM)。出院后1、2、3、6、9、12个月于门诊复查患肢正、侧位X线片,此后根据软组织及骨组织康复情况于门诊复查。上肢功能根据中华医学会手外科学会上肢部分功能评定试用标准评定。结果术后随访6~26个月,平均11.5个月。所有皮瓣无坏死及感染,骨关节缺损处无感染,Paley骨折愈合评分标准判断结果优10例,良2例,上肢功能根据中华医学会手外科学会上肢部分功能评定试用标准,优5例,良5例,可2例。植入桡骨远端及桡骨干假体患肢腕关节活动度背伸30°~42°(平均37.3°),腕关节屈曲40°~55°(平均43.5°);掌指骨假体指、腕关节活动度为60°~70°(平均65.7°)。结论3D打印个体化定制假体治疗上肢显微修复后骨和关节缺损是安全和精准有效的,可有效恢复上肢骨和关节缺损处的解剖结构。Objective To evaluate the efficacy of 3D printed individualised prosthesis in treating bone and joint defects in upper limbs remained after earlier microsurgical repairs.Methods From June 2019 to September 2021,12 patients were treated in the Institute of Orthopaedic Trauma of PLA,the 80th Group Army Hospital for bone and joint defects in upper limb that had been remained after earlier repairs with soft tissue flaps.The defects were:1 in completely severed wrist,2 defects of digit metacarpal bone,4 defects of interphalangeal joint,4 defects of bones in radiocarpal joint and 1 defect of lunate bone.The area of soft tissue defect ranged from 1.5 cm×3.0 cm to 12.0 cm×18.0 cm,and the length of bone defects ranged from 2.5 to 8.5(average 3.64)cm.For incompletely severed and completely severed limbs,replantation of severed limbs(digits)were performed in the primary surgery and the repair of soft tissue defects were performed in the second stage surgery.The remaining defects of bone and joint were reconstructed by 3D printed individualised prostheses in the third stage surgery.Finger soft tissue defects were covered with a local flap in the primary surgery,and bone and joint defects were reconstructed with a 3D printed prosthesis in the second surgery.Finger soft tissue defects were covered with a local flap in the first phase,and bone and joint defects were reconstructed with a 3D printed prosthesis in the second phase.After the surgery,the bone integration between the broken end of the bone joint defect and the prosthesis was determined based on the X-ray results and the Paley fracture healing score standard.Simultaneously measured the Total Active Motion(TAM)of the forearm and hand joints.At 1,2,3,6,9 and 12 months after hospital discharge.Follow-up X-ray examinations were taken followed by examinations on the recovery of soft tissues and bones.The upper limb function was graded according to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association.Results Postop

关 键 词：3D打印 上肢 软组织缺损 骨缺损 关节缺损 重建 显微外科 

分 类 号：R687.3[医药卫生—骨科学]