3D打印修复联合Masquelet技术治疗Cierny-Mader Ⅳ型长骨骨髓炎骨缺损的疗效分析

Curative effects of Masquelet technique and 3D printing for repair of Cierny-Mader typeⅣlong bone osteomyelitis

目的探讨3D打印修复联合Masquelet技术治疗Cierny-MaderⅣ型长骨骨髓炎骨缺损的疗效。方法回顾性研究自2017年6月至2019年12月北京大学第三医院骨科应用3D打印联合Masquelet技术治疗的8例Cierny-MaderⅣ型下肢慢性骨髓炎患者资料。男6例,女2例;年龄27~79岁,平均54.6岁;缺损部位:股骨干5例,股骨干骺端1例,胫骨干1例,胫骨干骺端1例;缺损长度7.7~15.5 cm,平均10.2 cm。第一阶段:局部感染控制及临时稳定重建(Masquelet技术);第二阶段:3D打印的假体及稳定模式设计;第三阶段:3D打印假体植入及康复。术后记录患者的膝、踝关节的运动范围,并采用Johner-Wruhs评分评价功能。结果8例患者术后获6~18个月(平均12.6个月)随访。患者从第一次入院到假体植入完成后出院,总治疗时间为65~125 d(平均91.0 d),其中第一阶段用时13~57 d(平均28.7 d),第二阶段用时30~87 d(平均48.3 d),第三阶段用时28~84 d(平均63.0 d),无内固定物松动及断裂。7例患者在假体置入术后14.7 d(4~42 d)恢复完全负重活动,1例患者因有严重骨质疏松症术后6个月恢复完全负重。8例患者术后关节功能恢复良好,膝关节的运动范围为0°~100°,踝关节的运动范围为35°背屈至40°趾屈。末次随访时采用Johner-Wruhs评分:优2例,良5例,中1例。结论应用3D打印修复联合Masquelet技术治疗Cierny-MaderⅣ型长骨骨髓炎骨缺损治疗周期短,患者可以早期康复,值得推广。

Objective To evaluate the curative effects of Masquelet technique and 3D printing in repair of Cierny-Mader typeⅣlong bone osteomyelitis.Methods A retrospective study was conducted of the 8 patients who had been treated at Department of Orthopaedics,The Third Affiliated Hospital to Peking University for Cierny-Mader typeⅣosteomyelitis of the lower extremity from June 2017 to December 2019.They were 6 males and 2 females,aged from 27 to 79 years(average,54.6 years).The defects involved femoral shaft in 5 cases,femoral metaphysis in one,tibia shaft in one,and tibial metaphysis in one.The defect lengths ranged from 7.7 to 15.5 cm,averaging 10.2 cm.Stage one was local infection control and temporary stability reconstruction using Masquelet technique,stage two design and 3D printing of the prosthesis and stable pattern design,and stage three prosthesis implantation and rehabilitation.The ranges of motion of the knee and ankle were recoded postoperatively and the functions evaluated using the Johner-Wruhs scores.Results The average follow-up time for the 8 patients was 12.6 months(from 6 to 18 months).The total treatment time from the first admission to the last discharge ranged from 62 to 125 days(average,91.0 days),the time for stage one from 13 to 57 days(average,28.7 days),that for stage two from 30 to 87 days(average,48.3 d),and that for stage three from 28 to 84 days(average,63.0 days).The infection was controlled and there was no recurrence,implant loosening or breakage.Seven patients were capable of full weight-bearing at 14.7 days(from 4 to 42 days)after surgery.One patient recovered full weight-bearing 6 months after surgery due to severe osteoporosis.Fine functional recovery was achieved in the 8 patients,with a range of motion from 0°to 100°for the knee and a range from 35°dorsal flexion to 40°toe flexion for the ankle.The Johner-Wruhs scores at the last follow-up showed 2 excellent,5 good and one moderate cases.Conclusion In repair of Cierny-Mader typeⅣlong bone osteomyelitis,Masquelet technique and 3D printing can shorten the treatment process and allow for early recovery.