3D打印技术在拇指及手指全形再造中的应用

The application of 3D printing technology in comprehensive reconstruction of thumb and finger

目的探讨3D打印技术在拇指及手指全形再造中的应用效果。方法选取2018年1月-2020年1月收治的67例指缺损患者(84指),其中拇指37指,手指47指,Ⅰ~Ⅲ度45指,Ⅳ~Ⅵ度39指。手术方式为3D打印技术辅助下的指全形再造。对患者的双手、双足进行CT平扫并3D建模,导出1∶1模型,打印指缺损部位的皮肤模型和骨关节模型。将皮肤模型套在足趾上,设计需要切取的甲瓣形状。按照骨关节模型截取第2足趾的趾骨间关节或跖趾关节(骨长度不够者取髂骨条串联)。门诊随访观察手术效果。结果84指再造指全部成活。术后随访3~24个月,再造指体外观与正常指体外观相近,质地、弹性良好,指甲平整、光滑、有光泽。感觉恢复为S3+,TPD为4~6 mm。按照中华医学会手外科学会上肢部分功能评定试用标准:优70指,良14指。共有64指供区保留了全部足趾,供区皮瓣色泽、质地较满意,不影响行走及跑跳,无行走痛等不适。结论3D打印技术辅助下的指全形再造,术中切取组织更精准,不仅提高了再造指的美观度,同时也避免了不必要的创伤,提高了患者满意度。

Objective To explore the application effect of 3D printing technology in comprehensive reconstruction of thumb and finger.Methods From January,2018 to January,2020,67 patients with 84 thumbs and fingers defects were selected,which were 37 thumbs and 47 fingers,and 45 of Ⅰ~Ⅲ degree and 39 of Ⅳ~Ⅵ degree.The method of operation was comprehensive reconstruction of thumbs and fingers assisted by 3D printing technology.The patient's hands and feet were scanned with CT and 3D modeling,and the 1∶1 model was derived.The skin model and bone model of thumb and finger defect were printed.Put the skin model on the great toes,and design the shape of the nail flap to be cut.Then the flap was spread in the groin area to design the perforating branch flap of the superficial circumflex iliac artery.The interphalangeal joint or metatarsophalangeal joint of the second toe was cut off according to the skeleton model(when the length of the bone joint was not enough,the iliac bone strip was taken to be connected in series).The effect of operation was observed in outpatient.Results All of the 84 thumbs and fingers survived and were followed-up for 3 to 24 months.The appearance of the reconstructed thumbs and fingers was similar to that of the normal ones,with good texture and elasticity.The nail was smooth and glossy.The sensory recovery was S3+,and the TPD was 4-6 mm.According to the Evaluation Standard of Finger Replantation and Reconstruction of Hand Surgery Society of Chinese Medical Association,70 thumbs and fingers were excellent and 14 thumbs and fingers were good.In 64 thumbs and fingers,all toes were preserved in the donor area,and the color and texture of the flap were satisfactory,which did not affect walking,running and jumping,and had no walking pain.Conclusion With the help of 3D printing technology,the tissues can be cut more accurately during the thumb and finger comprehensive reconstruction,which not only improves the beauty of reconstructed thumbs and fingers,but also avoids unnecessary trauma and improves the satisfaction of patients.