3D打印模拟手术联合定制钢板固定治疗小儿麻痹后遗症股骨干骨折

3D printing pre-operation assisted with custom-made plate for internal fixation of femoral shaft fractures after poliomyelitis

背景:小儿麻痹后遗症患者股骨常存在畸形,骨折后与常规内植物匹配度低,针对小儿麻痹后遗症畸形严重股骨干骨折的个体化治疗报道甚少。目的:探讨小儿麻痹后遗症股骨干骨折的临床特点及采用3D打印模拟手术联合定制钢板治疗的临床效果。方法:回顾性分析2015年5月至2018年5月采用3D打印模拟手术联合定制钢板治疗19例小儿麻痹后遗症股骨干骨折的患者资料,男11例,女8例;年龄38-62岁,平均52.5岁;左侧7例,右侧12例;股骨干骨折根据AO/OTA分型,A1型6例,A2型3例,A3型1例,B1型4例,B2型4例,C1型1例。所有患者对治疗方案均知情同意,且得到医院伦理委员会批准。患者术前均3D打印患肢1∶1股骨模型,并定制钢板,于股骨模型行体外模拟手术,明确钢板放置位置、测量并记录螺钉方向和长度,依据模拟手术结果行最终骨折内固定治疗。依据髋关节Harris评分、美国纽约特种外科医院膝关节评分评估患肢髋、膝关节功能。结果与结论:①19例患者术后随访12-18个月,所有骨折均获得骨性愈合,愈合时间5-12个月,平均6.6个月;②Harris评分伤前(84.95±5.18)分,术后1年(84.42±4.83)分;美国纽约特种外科医院膝关节评分伤前(84.53±4.36)分,术后1年(83.63±3.90)分。经统计学分析,伤前与术后1年的上述指标2组差异均无显著性意义(P>0.05);③所有患者无内固定松动、断裂发生;1例患者术后骨折延迟愈合,行取髂植骨后骨折愈合;1例患者术后出现伤口感染,予充分引流及静脉应用敏感抗生素及清创后伤口愈合;④提示小儿麻痹后遗症患者股骨常存在畸形且伴有不同程度骨质疏松,对于无法行常规内植物固定的股骨干骨折,3D打印模拟手术联合定制钢板可为治疗小儿麻痹后遗症特殊类型的股骨干骨折提供新的选择。

BACKGROUND:Patients with poliomyelitis often have abnormalities in the femur and the conventional plant matching degree of fracture is low.There are few reports on individualized treatment for severe deformity of femoral shaft fracture in poliomyelitis.OBJECTIVE:To summarize the clinical features of femoral shaft fracture in poliomyelitis and discuss the operative outcome of 3D printing pre-operation assisted with custom-made plate.METHODS:From May 2015 to May 2018,data of 19 patients with poliomyelitis surgically treated with 3D printing pre-operation assisted with custom-made plate were retrospectively analyzed.There were 11 males and 8 females with an average age of 52.5 years(range,38-62 years).There were 7 cases on the left side,and 12 cases on the right side.According to AO/OTA classification of femoral shaft fracture,there were type A1 in 6 cases,type A2 in 3 cases,type A3 in 1 case,type B1 in 4 cases,type B2 in 4 cases and type C1 in 1 case.All patients signed the informed consent.This study was approved by the Hospital Ethics Committee.The 3D printed 1:1 femur model and custom-made plate were designed.Operation was simulated in vitro in femoral model.The placement of the plate was identified.The direction and length of the screws were measured and recorded.The final internal fixation of fracture was performed according to the pre-operation results.Hip and knee functions in the affected limb were assessed based on Harris evaluation criterion and hospital for special surgery knee score evaluation criterion.RESULTS AND CONCLUSION:(1)All 19 patients were followed up for 12-18 months.Bone healing was obtained in all fractures,with a healing time of 5-12 months,averaging 6.6 months.(2)Harris score was(84.95±5.18)before injury,and(84.42±4.83)1 year after operation.Hospital for special surgery knee score was(84.53±4.36)before injury,and(83.63±3.90)1 year after operation.Statistical analysis showed no statistical difference between the two groups before and after the injury(P>0.05).(3)All patients had no internal fixation loosening or fracture.One patient had delayed bone healing and healed after iliac bone grafting.One patient developed wound infection after surgery,and received adequate drainage.Wound was healed after intravenous application of sensitive antibiotics.(4)Patients with poliomyelitis often have abnormalities in the femur with varying degrees of osteoporosis.For femoral shaft fractures that cannot be fixed with conventional internal fixation,3D printing pre-operation combined with custom-made steel plate provides a new choice for the treatment of femoral shaft fractures in poliomyelitis.