掌指关节假体个体化设计与应用:1例报告

Individualized design and clinical application of metacarpophalangeal joint prosthesis: a one-case report

背景:临床上掌指关节创伤严重毁损后大多直接截肢,此次研究主要尝试对毁损严重的掌指关节进行个体化假体置换,以期恢复患手部分功能。目的:通过3D打印技术与医用级聚醚醚酮材料机加工技术,探讨个体化掌指关节假体的设计、制作与临床应用。方法:(1)纳入右手机器绞伤男性患者1例,64岁。采用术前双手薄层螺旋CT扫描数据进行双手三维重建,计算机辅助设计右手掌指关节假体。该临床研究的实施符合《赫尔辛基宣言》和吉林大学第二医院对研究的相关伦理要求[批准号:(2018)年研审第(133),审批时间:2017-08-16];(2)将右手残存骨质、设计完善的右手掌指关节假体输入3D打印机设备和机加工设备,完成解剖形态个体化的右手掌指关节假体模型复现与制作;(3)利用打印模型进行术前模拟,术中即刻将掌指关节假体置入。结果与结论:(1)基于CT薄层扫描数据完成假体设计与制作,假体与母体吻合,手术复原手部解剖形态,皮瓣移植覆盖;(2)提示3D打印联合机加工技术实现个体化掌指关节假体的设计和应用为掌指关节毁损修复重建提供了一种方法,该技术的有益尝试可能成为骨修复、置换的新趋势。

BACKGROUND: Clinically, most of the metacarpophalangeal joints are directly amputated after severe injury. This study is mainly aimed at the treatment of severe destruction of metacarpophalangeal joint(individualized prosthesis arthroplasty), in order to restore some functions of hand.OBJECTIVE: Three-dimensional-printing technology and mechanical processing were used to produce prosthesis of metacarpophalangeal joint with medical-grade polyether-ether-ketone material, then to discuss their individualized design, manufacture and clinical application.METHODS:(1) One man with sprained right hand by machine, at the age of 64 years. Both hands were scanned with spiral CT before surgery,then the prosthesis of right metacarpophalangeal joint was designed with computer aid and three-dimensional reconstructed. This study was performed in strict accordance with the Declaration of Helsinki formulated by the World Medical Association. This study was approved by the Ethics Committee of the Second Hospital of Jilin University on 16 August 2017(approval No.(2018)(133)).(2) The remained bone and the prosthesis individualized designed for metacarpophalangeal joint of right hand were three-dimensional-printed, then mechanical processed,produced the prosthesis of individualized design for metacarpophalangeal joint.(3) Preoperative simulation was conducted using the printed models, and then the metacarpophalangeal joint prosthesis was implanted.RESULTS AND CONCLUSION:(1) The prosthesis was designed and produced based on the CT scanning data. It was anastomosed with the mother bone perfectly. Surgery reconstruct finished the recovery of anatomical morphology of the right hand and the flap was transplanted to cover the prosthesis.(2) In summary, the design and application of individualized metacarpophalangeal joint prosthesis is realized by three-dimensional printing combined with machining technology, which provides a method for repairing metacarpophalangeal joint. The clinical application of the technique may become a new trend of bone repair and arthroplasty.