掌指关节假体个体化设计与应用:1例报告
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摘要
背景:临床上掌指关节创伤严重毁损后大多直接截肢,此次研究主要尝试对毁损严重的掌指关节进行个体化假体置换,以期恢复患手部分功能。目的:通过3D打印技术与医用级聚醚醚酮材料机加工技术,探讨个体化掌指关节假体的设计、制作与临床应用。方法:(1)纳入右手机器绞伤男性患者1例,64岁。采用术前双手薄层螺旋CT扫描数据进行双手三维重建,计算机辅助设计右手掌指关节假体。该临床研究的实施符合《赫尔辛基宣言》和吉林大学第二医院对研究的相关伦理要求[批准号:(2018)年研审第(133),审批时间:2017-08-16];(2)将右手残存骨质、设计完善的右手掌指关节假体输入3D打印机设备和机加工设备,完成解剖形态个体化的右手掌指关节假体模型复现与制作;(3)利用打印模型进行术前模拟,术中即刻将掌指关节假体置入。结果与结论:(1)基于CT薄层扫描数据完成假体设计与制作,假体与母体吻合,手术复原手部解剖形态,皮瓣移植覆盖;(2)提示3D打印联合机加工技术实现个体化掌指关节假体的设计和应用为掌指关节毁损修复重建提供了一种方法,该技术的有益尝试可能成为骨修复、置换的新趋势。
BACKGROUND: Clinically, most of the metacarpophalangeal joints are directly amputated after severe injury. This study is mainly aimed at the treatment of severe destruction of metacarpophalangeal joint(individualized prosthesis arthroplasty), in order to restore some functions of hand.OBJECTIVE: Three-dimensional-printing technology and mechanical processing were used to produce prosthesis of metacarpophalangeal joint with medical-grade polyether-ether-ketone material, then to discuss their individualized design, manufacture and clinical application.METHODS:(1) One man with sprained right hand by machine, at the age of 64 years. Both hands were scanned with spiral CT before surgery,then the prosthesis of right metacarpophalangeal joint was designed with computer aid and three-dimensional reconstructed. This study was performed in strict accordance with the Declaration of Helsinki formulated by the World Medical Association. This study was approved by the Ethics Committee of the Second Hospital of Jilin University on 16 August 2017(approval No.(2018)(133)).(2) The remained bone and the prosthesis individualized designed for metacarpophalangeal joint of right hand were three-dimensional-printed, then mechanical processed,produced the prosthesis of individualized design for metacarpophalangeal joint.(3) Preoperative simulation was conducted using the printed models, and then the metacarpophalangeal joint prosthesis was implanted.RESULTS AND CONCLUSION:(1) The prosthesis was designed and produced based on the CT scanning data. It was anastomosed with the mother bone perfectly. Surgery reconstruct finished the recovery of anatomical morphology of the right hand and the flap was transplanted to cover the prosthesis.(2) In summary, the design and application of individualized metacarpophalangeal joint prosthesis is realized by three-dimensional printing combined with machining technology, which provides a method for repairing metacarpophalangeal joint. The clinical application of the technique may become a new trend of bone repair and arthroplasty.
BACKGROUND: Clinically, most of the metacarpophalangeal joints are directly amputated after severe injury. This study is mainly aimed at the treatment of severe destruction of metacarpophalangeal joint(individualized prosthesis arthroplasty), in order to restore some functions of hand.OBJECTIVE: Three-dimensional-printing technology and mechanical processing were used to produce prosthesis of metacarpophalangeal joint with medical-grade polyether-ether-ketone material, then to discuss their individualized design, manufacture and clinical application.METHODS:(1) One man with sprained right hand by machine, at the age of 64 years. Both hands were scanned with spiral CT before surgery,then the prosthesis of right metacarpophalangeal joint was designed with computer aid and three-dimensional reconstructed. This study was performed in strict accordance with the Declaration of Helsinki formulated by the World Medical Association. This study was approved by the Ethics Committee of the Second Hospital of Jilin University on 16 August 2017(approval No.(2018)(133)).(2) The remained bone and the prosthesis individualized designed for metacarpophalangeal joint of right hand were three-dimensional-printed, then mechanical processed,produced the prosthesis of individualized design for metacarpophalangeal joint.(3) Preoperative simulation was conducted using the printed models, and then the metacarpophalangeal joint prosthesis was implanted.RESULTS AND CONCLUSION:(1) The prosthesis was designed and produced based on the CT scanning data. It was anastomosed with the mother bone perfectly. Surgery reconstruct finished the recovery of anatomical morphology of the right hand and the flap was transplanted to cover the prosthesis.(2) In summary, the design and application of individualized metacarpophalangeal joint prosthesis is realized by three-dimensional printing combined with machining technology, which provides a method for repairing metacarpophalangeal joint. The clinical application of the technique may become a new trend of bone repair and arthroplasty.
引文
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[10]王凌椿,陈雁西,张建平,等.人工掌指关节置换术治疗类风湿关节炎手部畸形效果观察[J].山东医药,2015,55(4):88-89.
[11]侯桥,曾林如,申丰,等.保留关节的经掌指关节平面切割性离断断掌再植五例[J].中华显微外科杂志,2015,38(4):380-382.
[12]邵新中,张哲敏,吕莉,等.掌指关节外伤性缺损的治疗策略[J].骨科临床与研究杂志,2017,2(5):284-286.
[13]鄢荣曾,骆丹媚,秦晓宇,等.3D打印制作个性化下颌骨三维网状修复体支架数字化建模方法的研究[J].中华口腔医学杂志,2016,51(5):280-285.
[14]马东洋,曹健,庞超远,等.3D打印技术在血管化腓骨瓣重建下颌骨大型缺损中的应用[J].口腔颌面外科杂志,2017,27(2):100-105.
[15]刘正蓬,王雅辉,明颍,等.3D打印技术在脊柱外科的应用效果观察[J].临床医药文献电子杂志,2017,4(60):11729-11730.
[16]刘坤,吕滨,郑哲,等.心脏三维打印新技术的临床应用[J].中华放射学杂志,2016,50(1):68-69.
[17]刘坤,吕滨,郑哲,等.三维打印心脏病模型指导诊治复杂先天性心脏病3例[J].中华胸心血管外科杂志,2015,31(7):436-438.
[18]孙剑,3D打印技术在小儿心脏外科的应用[J].临床外科杂志,2016,24(1):30-33.
[19]程维,白长双,郝立昌.3D打印假体技术治疗四肢骨关节肿瘤[J].中国矫形外科杂志,2017,25(9):844-847.
[20]曲扬,艾松涛,杨飞,等.CT和MRI图像配准融合联合3D打印技术在难治性骨盆肿瘤术前规划中的应用[J].上海交通大学学报(医学版),2017,37(9):1238-1244.
[21]付军,郭征,范宏斌,等.应用3D打印假体重建下肢肿瘤性长节段骨缺损[J].中华骨科杂志,2017,37(7):433-440.
[22]王树辉,尹同珍,马红茹.3D打印模拟精准截骨在治疗儿童发育性髋脱位中的临床应用[J].中国中医骨伤科杂志,2018,26(10):57-59.
[23]Zhang H,Liu G,Tong XG,et al.Application of three-dimensional printing technology in the surgical treatment of nasal skull base tumor.Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi.2018;53(10):780-784.
[24]Lin M,Firoozi N,Tsai CT,et al.3D-printed flexible polymer stents for potential applications in inoperable esophageal malignancies.Acta Biomater.2019;83:119-129.
[25]赵晶斌,张小鹏,苏成洋,等.3D打印技术在Stanford B型主动脉夹层诊治中的应用进展[J].血管与腔内血管外科杂志,2018,4(2):169-174.
[26]Beltrami,G.,Ristori,G.,Scoccianti,G.,et al.Latissimus dorsi rotational flap combined with a custom-made scapular prosthesis after oncological surgical resection:a report of two patients.BMC Cancer.2018;18(1):1003.
[27]李盛华,邓昶,周明旺,等.骨科领域精准医疗的观念、特点及价值[J].中国组织工程研究,2018,22(15):2407-2413.
[2]Weightman B,Evans DM,Light D.The laboratory development of a new metacarpophalangeal prosthesis.Hand.1983;15(1):57-69.
[3]Doi K,Kuwata N,Kawai S.Alumina ceramic finger implants-a preliminary biomaterial and clinical-evaluation.J Hand Surg Am.1984;9(5):740-749.
[4]Moutet F,Guinard D,Gerard P,et al.A new titanium-carbon finger joint implant.Apropos of 15 initial cases.Ann Chir Main Memb Super.1994;13(5):345-353.
[5]王鹏,宣昭鹏,路来金,等.个体化钛合金掌指关节假体设计及快速成型制造的研究[J].中华手外科杂志,2008,24(6):377-379.
[6]杨永超,谈清,杨萃,等.碳化硅-碳复合材料用于小关节假体:生物力学研究及三维有限元分析[J].中国组织工程研究,2016,20(16):2333-2339.
[7]王鹏,路来金,宣昭鹏,等.个体化掌指关节假体三维建模及其髓内柄的计算机辅助设计[J].吉林大学学报(医学版),2008,34(1):147-149+173.
[8]杨涛,王利,陈传煌,等.改良第2跖趾关节复合组织移植重建掌指关节的解剖基础及临床应用[J].中国临床解剖学杂志,2011,29(1):105-108.
[9]程勇.切开复位微型钢板内固定术治疗掌指关节周围部位创伤骨折的临床分析[J].微创医学,2014,9(1):114-116.
[10]王凌椿,陈雁西,张建平,等.人工掌指关节置换术治疗类风湿关节炎手部畸形效果观察[J].山东医药,2015,55(4):88-89.
[11]侯桥,曾林如,申丰,等.保留关节的经掌指关节平面切割性离断断掌再植五例[J].中华显微外科杂志,2015,38(4):380-382.
[12]邵新中,张哲敏,吕莉,等.掌指关节外伤性缺损的治疗策略[J].骨科临床与研究杂志,2017,2(5):284-286.
[13]鄢荣曾,骆丹媚,秦晓宇,等.3D打印制作个性化下颌骨三维网状修复体支架数字化建模方法的研究[J].中华口腔医学杂志,2016,51(5):280-285.
[14]马东洋,曹健,庞超远,等.3D打印技术在血管化腓骨瓣重建下颌骨大型缺损中的应用[J].口腔颌面外科杂志,2017,27(2):100-105.
[15]刘正蓬,王雅辉,明颍,等.3D打印技术在脊柱外科的应用效果观察[J].临床医药文献电子杂志,2017,4(60):11729-11730.
[16]刘坤,吕滨,郑哲,等.心脏三维打印新技术的临床应用[J].中华放射学杂志,2016,50(1):68-69.
[17]刘坤,吕滨,郑哲,等.三维打印心脏病模型指导诊治复杂先天性心脏病3例[J].中华胸心血管外科杂志,2015,31(7):436-438.
[18]孙剑,3D打印技术在小儿心脏外科的应用[J].临床外科杂志,2016,24(1):30-33.
[19]程维,白长双,郝立昌.3D打印假体技术治疗四肢骨关节肿瘤[J].中国矫形外科杂志,2017,25(9):844-847.
[20]曲扬,艾松涛,杨飞,等.CT和MRI图像配准融合联合3D打印技术在难治性骨盆肿瘤术前规划中的应用[J].上海交通大学学报(医学版),2017,37(9):1238-1244.
[21]付军,郭征,范宏斌,等.应用3D打印假体重建下肢肿瘤性长节段骨缺损[J].中华骨科杂志,2017,37(7):433-440.
[22]王树辉,尹同珍,马红茹.3D打印模拟精准截骨在治疗儿童发育性髋脱位中的临床应用[J].中国中医骨伤科杂志,2018,26(10):57-59.
[23]Zhang H,Liu G,Tong XG,et al.Application of three-dimensional printing technology in the surgical treatment of nasal skull base tumor.Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi.2018;53(10):780-784.
[24]Lin M,Firoozi N,Tsai CT,et al.3D-printed flexible polymer stents for potential applications in inoperable esophageal malignancies.Acta Biomater.2019;83:119-129.
[25]赵晶斌,张小鹏,苏成洋,等.3D打印技术在Stanford B型主动脉夹层诊治中的应用进展[J].血管与腔内血管外科杂志,2018,4(2):169-174.
[26]Beltrami,G.,Ristori,G.,Scoccianti,G.,et al.Latissimus dorsi rotational flap combined with a custom-made scapular prosthesis after oncological surgical resection:a report of two patients.BMC Cancer.2018;18(1):1003.
[27]李盛华,邓昶,周明旺,等.骨科领域精准医疗的观念、特点及价值[J].中国组织工程研究,2018,22(15):2407-2413.