3D打印技术辅助设计下个体化定制半肩关节假体在肱骨近端重建肩关节置换术中的应用

doi:10.13481/j.1671-587x.20190324

摘要/Abstract

摘要： 目的：探讨3D打印技术辅助设计下个体化定制半肩关节假体在1例复杂肱骨近端骨折内固定物失效造成肱骨近端缺损患者肩关节置换术中的应用，为涉及关节骨缺损的修复和重建提供参考。方法：1例患者因左侧肱骨近端骨折切开复位内固定术后内固定物断裂、肱骨近端塌陷坏死入院。双侧肱骨CT扫描获取数据进行三维重建，使用3D打印技术制造患者健侧与患侧肱骨光固化树脂模型；根据骨质破坏范围设计截骨长度；以健侧肱骨镜像图像为基础设计患侧个体化定制半肩关节假体外形，通过电子束熔融技术制造Ti₆Al₄V半肩关节假体。术前使用患侧模型进行模拟截骨，使用定制假体与残余模型进行模拟匹配实验；术中行近端肱骨截骨后，按照术前设计位置植入定制假体。术后1、3、6和12个月分别对患者进行随访。结果：手术时间为150 min，术中出血量为290 mL。术后1、3、6和12月分别复查肱骨X线图像显示假体位置良好，无松动；患者无感染（血沉和C-反应蛋白水平正常）、脱位、神经损伤和假体周围骨折等并发症。UCLA肩关节评分：术前和术中13分，术后1个月15分，术后3个月22分，术后6个月28分，术后12个月30分。Constant-Murley肩关节功能评分：术前和术中21分，术后1个月28分，术后3个月61分，术后6个月65分，术后12个月70分。DASH上肢功能评分：术前DASH分为100分，术中100分，术后1个月63分，术后3个月50分，术后6个月44分，术后12个月25分。术后患肩日常生活能力恢复基本满意。结论：植入3D打印技术辅助设计下的个体化半肩关节假体可完成涉及关节骨缺损的解剖和功能重建，患者短期随访疗效明显。

关键词: 骨缺损, 内固定物失效, 3D打印, 个体化定制, 半肩关节置换

Abstract: Objective:To study the application of individualized semi-shoulder prosthesis under the assistance of 3D printing technology in the shoulder replacement surgery of one patient with bone defect caused by a complex proximal humerus fracture internal fixation failure, and to provide the basis for the repairment and reconstruction of articular bone defect. Methods:One patient was admitted to the hospital because of the internal fixation failure after open reduction and internal fixation for left proximal humeral fractures and proximal collapse and necrosis of humerus. The humerus CT data of this patient was collected and the three-dimensional reconstruction was conducted. The models of stereo lithography apparatus resin on healthy side and affected side of this patient were manufactured by 3D printing technology,and the length of osteotomy was designed preoperatively according to the bone destruction condition. The shape of customized prosthesis was designed on the basis of mirror image of the contralateral humerus head. The Ti₆Al₄V semi-shoulder prosthesis was manufactured by the means of Electron Beam Melting technology. The preoperative simulative operation was carried out,and the matching experiment of the customized prosthesis and residual humerus model was performed; the humerus osteotomy was performed in accordance with the preoperative design in operation. The customized prosthesis was implanted to the designed location. The patients were followed up at 1, 3, 6,and 12 months after operation. Results:The operation time was 150 min. The intraoperative blood loss was 290 mL. The postoperative humerus X-ray examination at 1, 3, 6,and 12 months after operation were performed and the results showed that the prosthesis was observed in good position without loosening. There were also no infection (ESR and C-reactive protein level were normal) as well as dislocation,nerve damage and periprosthetic fractures,etc. The UCLA scores were 13 points before and during operation,15 points at 1 month after operation,22 points at 3 months after operation, 28 points at 6 months after operation,and 30 points at 12 months after operation. The Constant-Murley scores were 21 points before and during operation,28 points at 1 month after operation,61 points at 3 months after operation, 65 points at 6 months after operation, and 70 points at 12 months after operation. The Disbility of Arm shoulder and Hand(DASH) scores were 100 points before and during operation,63 points at 1 month after operation,50 points at 3 months after operation, 44 points at 6 months after operation, 25 points at 12 months after operation. The rehabilitation of daily life ability of the affected shoulder of the patient after operation was satisfied. Conclusion:Individualized semi-shoulder joint prosthesis under assistance of 3D printing technology can achieve the perfect anatomy reconstruction and partial function restoration of shoulder joint and the curative effect of short-term follow-up of the patient isobvious.

Key words: bone defect, internal fixation failure, 3D printing, individualized, semi-shoulder replacement.

中图分类号:

R687.4

陈辰, 韩青, 陈炳鹏, 王辰宇, 张客松, 杨科荣, 王金成. 3D打印技术辅助设计下个体化定制半肩关节假体在肱骨近端重建肩关节置换术中的应用[J]. 吉林大学学报(医学版), 2019, 45(03): 614-620.

CHEN Chen, HAN Qing, CHEN Bingpeng, WANG Chenyu, ZHANG Kesong, YANG Kerong, WANG Jincheng. Application of individualized semi-shoulder prosthesis for proximal humerus reconstruction under assistance of 3D printing technology[J]. Journal of Jilin University(Medicine Edition), 2019, 45(03): 614-620.

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