3-D打印导航模板辅助肘关节肿瘤切除及个性化肘关节置换术的初步应用

发布时间：2018-06-05 06:07

  本文选题：人工肘关节置换术 + 肘关节假体　； 参考：《中国修复重建外科杂志》2017年04期

【摘要】：目的探讨3-D打印导航模板辅助肘关节肿瘤切除并为患者定制个性化肘关节假体成功实施肘关节置换术的临床方法。方法 2016年8月收治1例63岁左肱骨远端肿瘤男性患者。因发现左肱骨远端巨大包块3个月余,伴肘关节疼痛、活动受限入院。术前采用计算机辅助设计联合3-D打印技术,模拟肿瘤切除范围,定制肿瘤切除模板以及用于修复肿瘤切除后骨缺损的同种异体骨修剪模板,同时设计个性化肘关节假体。术中按照设计精确切除肿瘤并行肘关节重建术。结果该例患者手术顺利完成,术中肿瘤切除时间46 min,安装个性化肘关节假体与同种异体骨时间95 min;术中无需透视。术后1周行X线片及CT检查,示肘关节假体位置良好,尺骨假体前倾角为30°,肘关节提携角为15°,与术前模拟肘关节置换术效果一致。术后1个月手指屈伸活动正常,肘关节屈伸活动范围为0~130°,前臂旋前80°、旋后80°。术后7个月肘关节活动满足日常生活需要。肿瘤无复发、转移。结论对于肘关节保肢术,采用计算机辅助技术可实现术前模拟手术效果,通过制备导航模板提高了手术精准度,定制个性化肘关节假体成功为患者实施了肘关节置换术从而重建肘关节功能,且具有术中无需X线透视、缩短手术时间等优点。
[Abstract]:Objective to investigate the clinical method of elbow arthroplasty with 3-D printed navigation template assisted elbow tumor resection and customized personalized elbow prosthesis. Methods A 63-year-old male patient with left distal humeral tumor was treated in August 2016. The left distal humeral mass was found to be large for more than 3 months, accompanied by pain in the elbow joint and limited movement. Computer aided design (CAD) combined with 3-D printing technique was used to simulate the range of tumor resection, to customize the tumor removal template, and to design a personalized elbow prosthesis. The tumor was resected accurately and the elbow joint was reconstructed according to the design. Results the operation was completed successfully, the tumor resection time was 46 min, and the time of individualized elbow prosthesis and allograft bone was 95 min. No fluoroscopy was required during the operation. One week after operation, X-ray and CT examination showed that the position of elbow prosthesis was good, the antegrade angle of ulnar prosthesis was 30 掳and the carrying angle of elbow joint was 15 掳, which was consistent with the effect of simulated elbow arthroplasty before operation. The finger flexion and extension activity was normal 1 month after operation. The range of flexion and extension of elbow joint was 0 掳130 掳, forearm pronation 80 掳and pronation 80 掳. 7 months after operation, elbow joint activities met the needs of daily life. There was no recurrence and metastasis. Conclusion for limb salvage of elbow joint, computer aided technique can be used to simulate the operation before operation, and the accuracy of operation can be improved by making navigation template. The customized elbow prosthesis was successfully performed to reconstruct the function of the elbow joint in order to reconstruct the function of the elbow joint. It also has the advantages of no X-ray fluoroscopy during the operation and the shortening of the operation time and so on.
【作者单位】： 广州军区广州总医院骨病关节科;广州中医药大学研究生院;广东工业大学;
【基金】：广东省科技计划项目(2013B021800050) 广东省科技攻关项目(2013B021800055)~~
【分类号】：R738;TP391.73
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本文编号：1980916