3D打印骨和皮模型在拇指全形再造术中的临床应用  

Clinical application of 3D printed phalange and skin template in comprehensive reconstruction of thumb

作　　者：张宁[1,2] 贺椿媛 周可佳[4] 孙中平 王佳乐[1,2] 李东岳 李齐 吴琳琳 王华柱 ZHANG Ning;HE Chunyuan;ZHOU Kejia;SUN Zhongping;WANG Jiale;LI Dongyue;LI Qi;WU Linlin;WANG Huazhu(Department of Hand Microsurgery,Cangzhou Hospital of Integrated Traditional Chinese Medicine and Western Medicine,Cangzhou,Hebei Province 061001,China;Hebei Key Laboratory of Integrated Traditional Chinese Medicine and Western Medicine in Osteoarthrosis Research(Planning),Cangzhou,Hebei Province 061001,China;Department of Basic Medical,Cangzhou Medical College,Cangzhou,Hebei Province 061001,China;Department of Rehabilitation Medicine,Haibin People’s Hospital of Tianjin Binhai New District,Tianjin 300280,China)

机构地区：[1]河北省沧州中西医结合医院手显微外科,河北沧州061001 [2]河北省中西医结合骨关节病研究重点实验室(筹),河北沧州061001 [3]河北省沧州医学高等专科学校基础医学部,河北沧州061001 [4]天津市滨海新区海滨人民医院康复医学科,天津300280

出　　处：《中华显微外科杂志》2024年第2期154-159,共6页Chinese Journal of Microsurgery

摘　　要：目的探讨3D打印骨、皮模型在拇指全形再造术中的临床应用及效果。方法2018年1月-2022年12月,河北省沧州中西医结合医院手显微外科收治17例(19指)拇指缺损患者,其中Ⅰ度缺损5指,Ⅱ度缺损5指,Ⅲ度缺损8指,Ⅳ度缺损1指,其中16指为急诊无再植条件、毁损严重,3指为既往外伤术后指体残缺。再造术前行双手CT扫描,通过对侧正常拇指CT数据镜像建模,对比患指通过3D打印机打印出1∶1大小骨缺损部分及软组织缺损的模型。术中根据缺损的组织模型,切取趾骨甲皮瓣;根据缺损的骨骼模型,取髂骨(12指)及第2趾近侧趾骨间关节(5指)和跖趾关节(2指),与皮瓣中的部分趾骨重建拇指指骨长度及关节。术后绝对卧床、烤灯照射并对症治疗。再造拇指成活后1个月均行足趾创面游离植皮。出院后分别于再造术后3、6周和3、6、12个月指导或联系患者来院定期复查,观察再造指外观、血运、功能、感觉、色泽、TPD等情况。结果术后皮瓣有1指发生动脉危象,行探查动脉再通;1指术后皮下感染,经换药后愈合;其余17指无并发症。19指均成活,再造手指美观,足部无功能影响。术后随访3~12个月,平均8个月。再造指体外观良好;手指感觉按照英国医学研究会(BMRC)感觉功能评定标准评定,感觉恢复至S_(1)~S_(3)^(+);根据中华医学会上肢部分功能评定试用标准的指总主动活动度(TAM)评定,结果均为优。结论3D打印骨和皮模型在拇指全形再造术中应用,可辅助精准设计和切取皮瓣,重建指骨长度,提高手术效率。Objective To investigate the clinical application and effect of 3D printed phalangeal and skin template in comprehensive reconstruction of thumb.Methods From January 2018 to December 2022,17 patients with 19 thumbs injuries were treated in the Department of Hand Microsurgery of Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine.Five thumbs were in Grade I defect,5 in GradeⅡdefect,8 in GradeⅢdefect and 1 in GradeⅣdefect.Sixteen severely defected thumbs were due to lack of capability in reconstructive surgery,and 3 thumbs were severed in previous injury.CT scans of both hands were performed before the thumb reconstructive surgery.Mirroring digital models of normal contralateral thumbs were established based on CT scans to compare with the 3D printed templates(1∶1 ratio)of the defected phalange and soft tissue of the affected thumbs.Hullax nail flaps were harvested in surgery according to the templates of defected skin.The length and joint of the defected thumbs were reconstructed by iliac bone grafts(12 thumbs),the proximal interphalangeal joint of the second toe(5 thumbs)and metatarsophalangeal joint(2 thumbs)together with the phalangeal bone in the flaps.After surgery,the patients were managed with absolutely keeping in bed and treated with infrared lamp irradiation together with symptomatic treatment.Free skin grafting was performed 1 month after the reconstruction of the thumb.After discharge,the patients were instructed or contacted to come to the hospital for regular reviews at 3 weeks,6 weeks,3 months,6 months and 12 months after the reconstructive surgery,and the appearance,blood circulation,function,feeling,colour and TPD of the reconstructed thumbs were observed.Results Arterial congestion occurred in 1 thumb after surgery,and it was rectified after surgical exploration.One thumb had postoperative subcutaneous infection,and healed after dressing changes.The other 17 thumbs showed no complications.The postoperative follow-up lasted for 3-12 months,with 8 months in average.All

关 键 词：3D打印 拇指缺损 全形再造 趾骨甲皮瓣 数字医学 

分 类 号：R658.1[医药卫生—外科学]