目的 报道3D打印模块辅助创伤性骨缺损修复重建术的方法和疗效。 方法 纳入1名年轻女性病例，因交通事故致左膝开放性骨折并左股骨外髁缺损。Ⅰ期清创术后创面闭合2个月，基于患者CT原始数据，三维重建出股骨及股骨关节面的曲面模型，快速成型技术打印出相应的模块，术中辅助同种异体骨塑形，实现骨结构的修复重建。术后长期随访，通过主观感觉、影像表现、HSS评分等评价该治疗方法的有效性。 结果 术后1个月至8年随访期间，患肢疼痛、功能、关节活动度、肌力、膝关节屈曲畸形、膝关节不稳定等均呈良性发展，患肢活动功能满足日常需要。部分植骨块吸收，未见其它致残因素及明显不良事件发生。术后1月、2年、8年，HSS评分分别为44分、58分、83分。 结论 3D打印模块辅助手术能够提供个性化治疗，为创伤性骨缺损修复重建手术提高准确性，疗效肯定。
Abstract
Objective To investigate the feasibility and effectiveness of 3D printing module for reconstruction of traumatic bone defects. Methods A young female with an open fracture of the left knee associated with femoral condyle defect caused by traffic accident was included. The defect of lateral condyle of femur was repaired and reconstructed assisted by computer and 3D printing technique after the initial debridement and wound closure for 2 months, based on the original data of CT scans preoperative, the bone defect module and the femoral articular curvature surface model consistent with the anatomical shape of the healthy side were established by means of mirror operation, fusion registration and Boolean operation, and accurate preoperative planning was made. The corresponding 3D-module was made by rapid prototyping technology, and the femoral condyle of the defect was assisted to be shaped during the surgery, so as to achieve accurate repair and reconstruction of the bone structure. In the long-term follow-up after the operation, the effectiveness of the 3D printing module was evaluated by subjective sensation, image performance and HSS score. Results Postoperative follow-up was conducted from 1 month to 8 years, we detected that the pain, function, range of motion, muscle strength, knee flexion deformity and knee instability of the injured limb, and showed benign development. There were no significant adverse events or disabling factors except partial bone graft resorption, and the motor function of the injured limb met the needs of daily life during the follow-up. Postoperative follow-up of 1 month, 2 years and 8 years showed that the HSS scores were 44, 58 and 83 points, respectively. Conclusions 3D printing module is a perfect way to assist intraoperative surgery because it can improve the accuracy of surgical operation for the repair and reconstruction of traumatic bone defects and provide new ideas for personalized treatment.
关键词
骨缺损 /
修复重建 /
结构性植骨 /
计算机 /
3D打印
Key words
Bone defect /
Rehabilitation and reconstruction /
Structural bone graft /
Computer aided /
3-D printing
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基金
云南省重大科技专项计划-重大科技专项（生物医药）（2017ZF025）
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