摘要
目的探讨3D打印微孔钛(钽)假体重建下肢骨髓炎致大段骨缺损的疗效。方法回顾性分析2020年1月至2022年5月期间解放军联勤保障部队第九二〇医院骨科收治的18例下肢骨髓炎致大段骨缺损患者资料。男10例,女8例;年龄(45.3±14.1)岁;骨缺损侧别:左侧13例,右侧5例;骨缺损部位:股骨11例,胫骨7例。骨髓炎病程为1.0(1.0,3.5)年。骨缺损长度为8.35(6.50,9.84)cm。采用个性化3D打印微孔钛(钽)假体修复骨髓炎病灶清除术后大段骨缺损。术后观察患者的伤口愈合情况,采用Paley感染性骨缺损骨愈合评价标准、疼痛视觉模拟评分(VAS)、下肢功能量表(LEFS)及影像学检查综合评定患者的疗效。结果 18例患者术后获(12.2±0.3)个月随访。1例患者术后2个月发生伤口感染,微孔钛假体取出后行Ilizarov骨搬运术治疗;其余17例患者术后伤口均愈合良好。末次随访时18例患者的疼痛VAS评分为2.0(1.0,4.0)分,显著低于术前[(6.1±2.3)分];LEFS评分为54.00(34.50,69.25)分,显著高于术前[18.50(9.00,26.50)分],差异均有统计学意义(P<0.05)。末次随访时根据Paley感染性骨缺损骨愈合评价标准评定骨愈合情况:优16例,良1例,差1例;骨断端与假体整合良好。结论 3D打印微孔钛(钽)假体重建下肢骨髓炎致大段骨缺损的疗效良好,具有减轻患者疼痛、恢复患者肢体功能等优势。
Objective To evaluate the curative effects of 3D printed microporous titanium(tantalum)prosthesis in reconstruction of large segmental bone defects caused by lower extremity osteomyelitis.Methods A retrospective study was conducted to analyze the clinical data of 18 patients who had been treated for large segmental bone defects caused by lower extremity osteomyelitis between January 2020 to May 2022 at Department of Orthopaedics,The 920th Hospital of Joint Logistics Support Force.There were 10 males and 8 females with an age of(45.3±14.1)years.The defects were at the left side in 13 cases and at the right side in 5 cases,at the femur in 11 cases and at the tibia in 7 cases.The duration of osteomyelitis was 1.0(1.0,3.5)years.The length of bone defects was 8.35(6.50,9.84)cm.Their bone defects were repaired by an individually 3D printed microporous titanium(tantalum)prosthesis after operative removal of osteomyelitis lesions.The wound healing was observed after surgery.The clinical efficacy was comprehensively evaluated by the Paley grading for bone defect healing,visual analog scale(VAS),lower extremity functional scale(LEFS),and imaging examination.Results The postoperative follow-up period for the 18 patients was(12.2±0.3)months.Wound infection occurred 2 months after surgery in one patient who was treated with Ilizarov bone transfer after removal of the microporous titanium prosthesis.The remaining 17 patients had good postoperative wound healing.At the last follow-up,the 18 patients had a VAS pain score of 2.0(1.0,4.0)points,significantly lower than the preoperative one[(6.1±2.3)points],and a LEFS score of 54.00(34.50,69.25)points,significantly higher than the preoperative one[18.50(9.00,26.50)points](P<0.05).At the last follow-up,according to the Paley grading,the bone union was rated as excellent in 16 patients,as good in 1 patient and as poor in 1 patient.The integration of femoral fractures with 3D printed microporous titanium prostheses was fine.Conclusion In reconstruction of large segmental bone defects caused by lower extremity osteomyelitis,implantation of a 3D printed microporous titanium(tantalum)prosthesis is feasible and effective,not only reducing pain but also restoring the limb function.
作者
杨银
徐永清
李刚
刘华
洪建斌
童伟
刘兴强
范新宇
Yang Yin;Xu Yongqing;Li Gang;Liu Hua;Hong Jianbin;Tong Wei;Liu Xingqiang;Fan Xinyu(Department of Orthopaedics,The 920th Hospital of Joint Logistics Support Force,Kunming 650032,China;Clinical School of Medicine,Dali University,Dali 671000,China;Department of Orthopaedics,Dali Bai Autonomous Prefecture Peoples's Hospital,Dali 671000,China)
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2024年第3期247-254,共8页
Chinese Journal of Orthopaedic Trauma
基金
云南省骨科与运动康复临床医学研究中心专项基金(202102AA310068)
云南省创伤骨科临床医学中心项目(ZX20191001)
全军临床重点专科建设项目
联勤医学重点专科项目。
关键词
下肢
骨髓炎
假体和植入物
钛
钽
大段骨缺损
3D打印技术
Lower extremity
Osteomyelitis
Prostheses and implants
Titanium
Tantalum
Large segmental bone defects
3D printing technology
