3D打印辅助下自体肋骨肋软骨交界段移植重建创伤性手指关节缺损的短期疗效

Short term efficacy on 3D printing assisted reconstruction of traumatic digit joint defects using rib and costoosteochondral autograft

目的探讨采用3D打印辅助下采用自体肋骨肋软骨交界段移植重建创伤性手指关节缺损的短期疗效。方法2022年8月-2023年7月,中国人民解放军联勤保障部队第九八八医院骨科对7例开放性手指关节缺损的患者,急诊一期清创骨折固定,骨缺损较多无法对位的患者给予抗生素骨水泥填充,二期行骨水泥取出,在3D打印辅助下肋骨肋软骨交界段移植重建手指关节缺损;按照3D打印出的1∶1手部模型,将肋骨肋软骨制作出关节外形,与关节及骨缺损部位拼接后固定。术后复查X线,并按照Paley骨折愈合评分标准判断肋骨与掌、指骨断端愈合情况;门诊随访,测量移植关节活动度,上肢功能根据中华医学会手外科学会上肢部分功能评定试用标准评定,并记录患指及供区视觉模拟评分法(VAS)标准评分。结果术后7例患者手部伤口均一期愈合,1例供区伤口出现脂肪液化,其余均一期愈合。1例因指伸肌腱损伤,肋骨肋软骨交界段移植术后再次行伸肌腱修复手术。7例患者术后获得6~11个月随访,平均9个月。Paley骨折愈合评分标准判断结果,7例患者骨折愈合均为优。末次随访手指关节活动度,近侧指骨间关节(4例)屈、伸活动度为40°~80°(平均56.2°),掌指关节(1例)背伸10°、屈曲85°,拇指指骨间关节(2例)活动度为20°~35°(平均27.5°)。手部功能参照中华医学会手外科学会上肢部分功能评定试用标准评定:优3例,良3例,可1例。结论本组针对一部分创伤性手指关节缺损的患者,采用肋骨肋软骨交界段切取制作成型,移植重建缺损部位关节,明显改善了创伤关节的外形及功能,尤其适用于合并指骨不规则缺损的患者。

ObjectiveTo explore the short-term efficacy on 3D printing assisted reconstruction of traumatic digit joint defects using rib and costo-osteochondral autograft.MethodsFrom August 2022 to July 2023,7 patients with open digit joint defects had undergone emergency primary debridement and fracture fixation in the Department of Orthopaedics,988th Hospital of the Joint Logistics Support Force of PLA.Patients with more phalangeal defects that could not be aligned were treated with antibiotic bone cement filling in the emergency surgery.In the second stage surgery,bone cement was removed and transfer of rib cartilage graft was performed to reconstruct the digit joint defect.According to a 1∶13D printed hand templates,rib cartilage grafts were crafted to the shape of digit joints,and then spliced together the digit joints and bone defects for fixation.Follow-up X-ray examinations were taken and assessment of the healing status of rib and fractures of phalangeal and metacarpophalangeal bones were carried out according to the Paley fracture healing score.At the outpatient follow-up,assessment of transferred joint movement and evaluation of upper limb function were conducted according to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association.Visual Analogue Scale(VAS)pain scores were evaluated from the affected digits and donor sites.ResultsAfter reconstructive surgery,all 7 patients had primary healing of the wounds of hand.One patient had fat liquefaction at the donor site,and the rest had primary donor site healing.One patient received further surgery for extensor tendon repair after rib cartilage grafting due to the digital extensor tendon injury.All 7 patients were included in postoperative follow-up for 6-11 months,with an average of 9 months.All patients had excellent fracture healing according to the Paley fracture healing score.At the final follow-up,the extension and flexion of the digit joints were found at 40°-80°(average 56.2°)for proximal interphalangeal joints(4 patients),and 10°in extension and 85°in flexion for metacarpophalangeal joint(1 patient).The range of motion of the thumb interphalangeal joint(2 patients)was 20°-35°(average 27.5°).Hand function was assessed according to Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association and it was found that 3 patients were in excellent,3 in good and 1 in fair.ConclusionThis study focused on the treatment of traumatic digit joint defects by transfer of individually crafted rib cartilages in reconstruction of the defected digit joint.It significantly improves the appearance and function of the defected digit joints,especially suitable for the irregular defects of phalangeal bones.