Dalhousie Medical School, Halifax, Nova Scotia, Canada (TD).
Division of Orthopedic Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada (DL, JM).
Foot Ankle Spec. 2022 Aug;15(4):361-368. doi: 10.1177/1938640020954819. Epub 2020 Sep 9.
Patients with large bony defects of the ankle who wish to avoid amputation have limited surgical intervention options for limb salvage. Each of these interventions are technically complex and present significant risk for complications. The use of a patient-specific 3D-printed titanium cage in conjunction with a tibiotalocalcaneal (TTC) arthrodesis using a retrograde nail is another management option. This case adds to the scarce published literature on this technique.
This report presents the case of a 16-year-old female who suffered a traumatic partial amputation of her left distal lower extremity following an all-terrain-vehicle accident that resulted in a 10.0 × 10.0 cm skin laceration and a 5-cm subsegmental bony loss of the distal tibia. She was successfully treated using a patient-specific 3D-printed titanium truss cage in conjunction with a TTC arthrodesis using a retrograde nail.
The decision to amputate or attempt limb salvage in a severely injured lower limb is still a topic of active debate. However, literature has shown that patients who undergo limb salvage surgery have better psychological health outcomes and equivalent functional outcomes as patients who have undergone amputation. Therefore, research on techniques that optimize and advance limb salvage surgery is needed. As the numerous potential benefits and limitations of patient-specific 3D-printed implants are assessed throughout the field of orthopedics, further research and cost-analysis will be required. Cases such as the one presented add to the limited existing literature of patient-specific 3D-printed implant for treatment of large distal lower extremity bony defects.
Level V (Case Report).
对于希望避免截肢的踝关节大骨缺损患者，肢体挽救的手术干预选择有限。这些干预措施中的每一种都具有技术复杂性，并且存在严重并发症的风险。使用患者特异性 3D 打印钛笼结合逆行钉进行距下胫腓关节（TTC）融合术是另一种治疗选择。该病例增加了该技术在文献中的稀缺性。
本报告介绍了一名 16 岁女性的病例，她在全地形车事故中遭受左下肢远端部分截肢，导致 10.0×10.0 厘米皮肤裂伤和 5 厘米胫骨远端亚段骨丢失。她成功地接受了患者特异性 3D 打印钛桁架笼结合逆行钉 TTC 融合术治疗。
在严重受伤的下肢中，是否截肢或尝试保肢仍然是一个活跃的辩论话题。然而，文献表明，接受保肢手术的患者具有更好的心理健康结果和与接受截肢的患者等效的功能结果。因此，需要研究优化和推进保肢手术的技术。随着骨科领域对患者特异性 3D 打印植入物的众多潜在益处和局限性进行评估，需要进一步的研究和成本分析。像所介绍的病例这样的病例增加了患者特异性 3D 打印植入物治疗大的远端下肢骨缺损的有限现有文献。
5 级（病例报告）。
