3D打印技术辅助个性化定制钢板在膝关节周围骨肿瘤中的应用
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摘要
目的:评价3D打印技术辅助个性化定制钢板治疗膝关节周围骨肿瘤的临床疗效。方法:选取自2014年12月—2016年12月收治的膝关节周围骨肿瘤患者15例,术前行CT及MRI扫描,数据导入Mimics软件内进行三维重建,所建模型进行3D打印,获得实体模型。根据股骨长度和病损范围设计个性化钢板,使用CNC数控机床进行钢板制作,个性化钢板用于骨肿瘤切除内固定术中。结果:平均手术时间约4h,平均随访时间29.3月,无病理性骨折,无钢板断裂并发症发生,所有患者术后均无局部复发,无感染并发症。按照Ennking功能评分标准评估下肢功能,平均为27分,术后恢复良好。结论:使用个性化定制钢板能减少手术时间,降低并发症的发生,临床疗效良好,远期效果有待进一步观察。
Objective: To evaluate the application of 3D printing assisted with personalized plate in the treatment of bone tumor around the knee. Methods: From December 2014 to December 2016, a total of fifteen patients with bone tumors around the knee were enrolled. All patients were performed with CT and MRI scans before operation. The collected data of scanned images were imported into Mimics software for 3D reconstruction and 3D printing. The length and shape of the plate were determined according to the length of the femur and the extent of the bone lesion area, and the plate was fabricated using a CNC numerical control grinder.Personalized titanium plates were used for bone tumor resection and plate screw internal fixation. Results: The mean operative time was 4 h. The average follow-up time was 29.3 months. There were no pathological fractures and no plate fracture happened. None of the patients had local recurrence or infection complications. According to the Ennking functional scoring criteria, the mean Enneking score was 27. All these data confirmed an excellent postoperative recovery. Conclusion: Using personalized titanium plates can reduce the operation time and reduce the occurrence of plate related complications, and also showed an excellent clinical effect, although the long-term follow-up is expected.
Objective: To evaluate the application of 3D printing assisted with personalized plate in the treatment of bone tumor around the knee. Methods: From December 2014 to December 2016, a total of fifteen patients with bone tumors around the knee were enrolled. All patients were performed with CT and MRI scans before operation. The collected data of scanned images were imported into Mimics software for 3D reconstruction and 3D printing. The length and shape of the plate were determined according to the length of the femur and the extent of the bone lesion area, and the plate was fabricated using a CNC numerical control grinder.Personalized titanium plates were used for bone tumor resection and plate screw internal fixation. Results: The mean operative time was 4 h. The average follow-up time was 29.3 months. There were no pathological fractures and no plate fracture happened. None of the patients had local recurrence or infection complications. According to the Ennking functional scoring criteria, the mean Enneking score was 27. All these data confirmed an excellent postoperative recovery. Conclusion: Using personalized titanium plates can reduce the operation time and reduce the occurrence of plate related complications, and also showed an excellent clinical effect, although the long-term follow-up is expected.
引文
[1]郭卫.肢体恶性骨肿瘤保肢治疗的方法及原则[J].北京大学学报(医学版),2012(6):824-827.
[2]左健,建敏,潘乐.同种异体骨移植用于骨缺损修复的应用现状[J].中国组织工程研究,2012(18):3395-3398.
[3]Gueorguiev B,Lenz M.Why and how do locking plates fail?[J].Injury,2018,49(Suppl1):S56-S60.
[4]王文,左贵来,王凡,等.3D打印手术导板结合桥接内固定系统异型块治疗股骨复杂骨折[J].中国矫形外科杂志,2017(22):2086-2090.
[5]韩国嵩,马广文,黄斐,等.3D打印技术在骨科中的研究进展[J].安徽医药,2015(12):2259-2262.
[6]Zeng C,Xing W,Wu Z,et al.A combination of three-dimensional printing and computerassisted virtual surgical procedure for preoperative planning of acetabular fracture reduction[J].Injury,2016,47(10):2223-2227.
[7]Xu M,Zhang L,Zhang Y,et al.Custommade Locked Plating for Acetabular Fracture:APilot Study in 24 Consecutive Cases[J].Orthope dics,2014,37(7):e660-e670.
[8]Augat P,von Ruden C.Evolution of fracture treatment with bone plates[J].Injury,2018,49(Suppl 1):S2-S7.
[9]Foo TL,Gan AW,Soh T,et al.Mechanical failure of the distal radius volar locking plate[J].JOrthop Surg(Hong Kong),2013,21(3):332-336.
[10]付军,郭征,王臻,等.多种3-D打印手术导板在骨肿瘤切除重建手术中的应用[J].中国修复重建外科杂志,2014(3):304-308.
[11]Xu M,Zhang L,Zhang Y,et al.Development of Site-specific Locking Plates for Acetabular Fractures[J].Orthopedics,2013,36(5):e593-e600.
[12]Wang Q,Hu J,Guan J,et al.Proximal third humeral shaft fractures fixed with long helical PHILOS plates in elderly patients:benefit of pre-contouring plates on a 3D-printed model-a retrospective study[J].Journal of Orthopaedic Surgery and Research,2018,13(1).
[13]兰小勇,饶伟,冯捷,等.3D打印结合定制钢板内固定技术治疗骨盆骨折临床疗效分析[J].江西医药,2017(11):1114-1116.
[14]Ankit Shrivastava,李建宏,戴琎,等.3D打印技术结合定制锁定加压钢板微创治疗股骨多段粉碎性骨折[J].临床骨科杂志,2017(3):383-384.
[15]Hu C,Zhou K,Pan F,et al.Application of pre-contoured anatomic locking plate for treatment of humerus split type greater tuberosity fractures:A prospective review of 68cases with an average follow-up of 2.5 years[J].Injury,2018,49(6):1108-1112.
[16]Hung C,Li Y,Chou Y,et al.Conventional plate fixation method versus pre-operative virtual simulation and three-dimensional printing-assisted contoured plate fixation method in the treatment of anterior pelvic ring fracture[J].International Orthopaedics,2018.
[17]Ding HW,Yu GW,Tu Q,et al.Computeraided resection and endoprosthesis design for the management of malignant bone tumors around the knee:outcomes of 12 cases[J].BMCMusculoskelet Disord,2013(14):331.
[2]左健,建敏,潘乐.同种异体骨移植用于骨缺损修复的应用现状[J].中国组织工程研究,2012(18):3395-3398.
[3]Gueorguiev B,Lenz M.Why and how do locking plates fail?[J].Injury,2018,49(Suppl1):S56-S60.
[4]王文,左贵来,王凡,等.3D打印手术导板结合桥接内固定系统异型块治疗股骨复杂骨折[J].中国矫形外科杂志,2017(22):2086-2090.
[5]韩国嵩,马广文,黄斐,等.3D打印技术在骨科中的研究进展[J].安徽医药,2015(12):2259-2262.
[6]Zeng C,Xing W,Wu Z,et al.A combination of three-dimensional printing and computerassisted virtual surgical procedure for preoperative planning of acetabular fracture reduction[J].Injury,2016,47(10):2223-2227.
[7]Xu M,Zhang L,Zhang Y,et al.Custommade Locked Plating for Acetabular Fracture:APilot Study in 24 Consecutive Cases[J].Orthope dics,2014,37(7):e660-e670.
[8]Augat P,von Ruden C.Evolution of fracture treatment with bone plates[J].Injury,2018,49(Suppl 1):S2-S7.
[9]Foo TL,Gan AW,Soh T,et al.Mechanical failure of the distal radius volar locking plate[J].JOrthop Surg(Hong Kong),2013,21(3):332-336.
[10]付军,郭征,王臻,等.多种3-D打印手术导板在骨肿瘤切除重建手术中的应用[J].中国修复重建外科杂志,2014(3):304-308.
[11]Xu M,Zhang L,Zhang Y,et al.Development of Site-specific Locking Plates for Acetabular Fractures[J].Orthopedics,2013,36(5):e593-e600.
[12]Wang Q,Hu J,Guan J,et al.Proximal third humeral shaft fractures fixed with long helical PHILOS plates in elderly patients:benefit of pre-contouring plates on a 3D-printed model-a retrospective study[J].Journal of Orthopaedic Surgery and Research,2018,13(1).
[13]兰小勇,饶伟,冯捷,等.3D打印结合定制钢板内固定技术治疗骨盆骨折临床疗效分析[J].江西医药,2017(11):1114-1116.
[14]Ankit Shrivastava,李建宏,戴琎,等.3D打印技术结合定制锁定加压钢板微创治疗股骨多段粉碎性骨折[J].临床骨科杂志,2017(3):383-384.
[15]Hu C,Zhou K,Pan F,et al.Application of pre-contoured anatomic locking plate for treatment of humerus split type greater tuberosity fractures:A prospective review of 68cases with an average follow-up of 2.5 years[J].Injury,2018,49(6):1108-1112.
[16]Hung C,Li Y,Chou Y,et al.Conventional plate fixation method versus pre-operative virtual simulation and three-dimensional printing-assisted contoured plate fixation method in the treatment of anterior pelvic ring fracture[J].International Orthopaedics,2018.
[17]Ding HW,Yu GW,Tu Q,et al.Computeraided resection and endoprosthesis design for the management of malignant bone tumors around the knee:outcomes of 12 cases[J].BMCMusculoskelet Disord,2013(14):331.