3D打印辅助Masquelet膜诱导技术治疗跟骨骨缺损的疗效研究

3D Printing assisted masquelet technique in the treatment of calcaneal defects

目的总结3D打印结合Masquelet膜诱导技术在治疗跟骨骨缺损中的临床疗效。方法回顾性分析2018年1月—2019年4月河南省洛阳正骨医院采用3D打印结合Masquelet膜诱导技术治疗的跟骨骨缺损患者4例,男性2例,女性2例;年龄22~52岁,平均36.0岁;道路交通伤2例,高处坠落伤1例,挤压伤1例。CT扫描重建双侧跟骨,根据镜像技术构建骨缺损区,利用3-Matic软件设计跟骨塑型器模具,3D打印模具。术中利用模具将骨水泥塑型并填充骨缺损,第二阶段手术取出骨水泥,植入自体骨修复骨缺损。观察患者骨料愈合情况,采用Maryland足部评分和美国足踝外科协会(AOFAS)评分评价足部和踝关节功能。结果患者均获随访,随访时间10~18个月,平均14.0个月。利用3D打印的模具将骨水泥塑型,术中发现与跟骨断端匹配度高,无需再次调整,一期术后伤口愈合良好。第二阶段手术发现,形成的诱导膜完整,大小适当;术中骨水泥取出顺利。骨折愈合时间为3~6个月,平均4.0个月。末次随访时无疼痛,可完全负重行走。Maryland足部评分88~98分,平均94.0分,其中优3例、良1例;AOFAS评分86~98分,平均92.8分,优3例,良1例。结论 3D打印骨水泥塑型器制作个性化骨水泥与骨缺损匹配度高,形成大小可控的诱导膜,骨水泥取出方便,保证诱导膜质量,对于跟骨骨缺损的修复效果满意。

Objective To summarize the clinical efficacy of 3D printing technology combined with Masquelet membrane induction technology in the treatment of calcaneal bone defects.Methods From Jan.2018 to Apr.2019,4 patients with calcaneal bone defects were treated with 3D printing technology combined with Masquelet membrane induction technology in Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital).There were 2 males and 2 females,aged 22-52 years,with an average of 36.0 years;There were 2 cases of road traffic injuries,1 case of fall from height,and 1 case of crush injury.CT scanning was used to reconstruct the bilateral calcaneus,the bone defect area was constructed according to the mirror image technology,the3-Matic software was used to design the calcaneus shaper mold,and then the mold was printed through 3D technology.During the operation,a mold was used to shape the bone cement and fill the bone defect.In the second stage,the bone cement was removed,and then autologous bone was implanted to repair the bone defect.The patient’s bone healing was observed,and the Maryland foot score and the American Association of Foot and Ankle Surgery (AOFAS)score were used to evaluate foot and ankle joint function.Results All 4 patients were followed up for 10-18 (14.0on average) months.The 3D printing mold was used to shape the bone cement.During the operation,it was found to have a high degree of matching with the stump of the calcaneus,and there was no need to adjust it again.The wound healed well after the first-stage operation.In the second stage of surgery,it was found that the induced membrane formed was complete and the size was appropriate,and the bone cement was taken out smoothly during the operation.The fracture healing time was 3-6(4.0 on average) months.At the last follow-up,there was no pain and patients could walk with full load.The Maryland score was 88-98(94.0 on average) points,and showed 3 cases of excellent and 1 case of good.The AOFAS score was 86-98(92.8 on average)points,and showed 3 cases of excellent,and 1case of good.Conclusion 3D printing technology combined with induced membrane technology to treat calcaneal bone defects has definite curative effect and is worthy of clinical promotion.