三维打印辅助 Masquelet 技术治疗跟骨缺损。
Three-Dimensional Printing-Assisted Masquelet Technique in the Treatment of Calcaneal Defects.
机构信息
Henan University of Traditional Chinese Medicine, Zhengzhou Henan, China.
Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang Henan, P.R. China.
出版信息
Orthop Surg. 2021 May;13(3):876-883. doi: 10.1111/os.12873. Epub 2021 Mar 25.
OBJECTIVE
The aim of the present study was to summarize the clinical efficacy of three-dimensional (3D) printing technology combined with the Masquelet technique in the treatment of calcaneal defects.
METHODS
From January 2018 to April 2019, 3D printing combined with induced masquelet technology was used to treat four patients with calcaneal defects, including two men and two women. The patients were aged 22-52 years old, with an average age of 36 years. There were two cases of traffic accident injuries, there was one case of a fall from height, and there was one case of crush injury. CT scans were used to reconstruct the bilateral calcaneus, mirror technology was used to construct the bone defect area, and Materialise 3-matic software was used to design the calcaneus shaper mold and 3D print the mold. During the operation, the mold was used to shape the bone cement and fill the bone defect. In the second stage, the bone cement was removed and autologous bone was implanted to repair the bone defect. All patients were followed up to observe the effect.
RESULTS
All four patients were followed up for 14 months (range, 10-18 months). There were three cases of infectious bone defects: two cases of Escherichia coli and one case of Pseudomonas aeruginosa. The 3D printed mold was used to shape the bone cement. During the operation, it was found to have a high degree of matching with the defect area of calcaneus. There is no need to adjust it again, and the wound healed well after the first stage. In the second stage of surgery, it was found that the induced membrane formed was complete and of appropriate size; the bone cement was easily removed during the operation. The fracture healing time was 3-6 months, with an average of 4 months. At the last follow up, there was no pain and the patients walked with full weight bearing. The Maryland score was 94 points (range, 88-98 points); three cases were excellent and one case was good. The AOFAS score ranged from 86 to 98, with an average of 92.8 points; three cases were excellent and one case was good.
CONCLUSION
Three-dimensional printing technology combined with induced membrane technology is an effective approach for treating calcaneal bone defects.
目的
本研究旨在总结三维（3D）打印技术结合 Masquelet 技术治疗跟骨缺损的临床疗效。
方法
2018 年 1 月至 2019 年 4 月，采用 3D 打印结合诱导 Masquelet 技术治疗跟骨缺损患者 4 例，男 2 例，女 2 例；年龄 22-52 岁，平均 36 岁；交通伤 2 例，高处坠落伤 1 例，压砸伤 1 例。采用 CT 扫描重建双侧跟骨，镜像技术构建骨缺损区，使用 Materialise 3-matic 软件设计跟骨成型模具并 3D 打印模具。术中模具用于塑形骨水泥填充骨缺损，二期去除骨水泥植入自体骨修复骨缺损。所有患者均获得随访，观察疗效。
结果
4 例患者均获随访，随访时间 14 个月（10-18 个月）。感染性骨缺损 3 例：大肠埃希菌 2 例，铜绿假单胞菌 1 例。3D 打印模具用于塑形骨水泥，术中发现与跟骨缺损区高度匹配，无需再次调整，一期伤口愈合良好。二期手术发现诱导膜形成完整，大小合适，术中骨水泥易去除。骨折愈合时间 3-6 个月，平均 4 个月。末次随访时，患者均无疼痛，可完全负重行走，Maryland 评分 88-98 分，平均 94 分；优 3 例，良 1 例。AOFAS 评分 86-98 分，平均 92.8 分；优 3 例，良 1 例。
结论
3D 打印技术结合诱导膜技术是治疗跟骨骨缺损的有效方法。
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