Broughton Kimberly K, Chien Bonnie, Stenquist Derek, Williams Caroline, Miller Christopher P, Kwon John Y
Department of Orthopaedic Surgery, Brigham and Women's Hospital Brigham and Women's Hospital, 1153 Centre St, 5 South, MA, 02130, Boston, USA.
Harvard Combined Orthopaedic Residency Program Massachusetts General Hospital, 55 Fruit Street, MA, 02114, Boston, USA.
3D Print Med. 2021 Sep 17;7(1):30. doi: 10.1186/s41205-021-00117-5.
With today's expanding use of total ankle arthroplasty, the ever-present trauma patient, and patients with uncontrolled comorbid conditions, surgeons face significant challenges for lower extremity reconstruction. These patients highlight some of those who may present with unique anatomy, bone loss, infection, and various other local and systemic factors that affect treatment options for successful outcomes. Three dimensional (3-D) printing for medical devices is allowing for new and customized ways to meet patient and surgeon goals of limb salvage and reconstruction.
While the majority of 3-D printing is done for the purpose of implantation, we present a technical tip for designing a 3-D printed mold from which to create an antibiotic cement spacer for implantation. With two case illustrations including a talus fracture nonunion and infected subtalar arthrodesis nonunion, we describe the process of patient selection, implant design, fabrication, and implantation of a custom molded antibiotic cement talus.
Case illustrations present two successful limb salvage patients while giving a thorough explanation of our technique, learned tips and tricks. This applied technology builds on prior use of antibiotic cement in limb salvage of the lower extremity, most of which are joint sacrificing. 3-D printing the mold for an anatomic talus cement spacer results in a joint sparing limb salvage solution. Innovative 3-D printing technology is merged with current, pertinent literature regarding antibiotic cement to offer surgeons expanded options for temporary or definitive reconstructive techniques in some of the most challenging patients.
随着当今全踝关节置换术的使用不断增加，创伤患者以及合并症未得到控制的患者日益增多，外科医生在下肢重建方面面临重大挑战。这些患者凸显了一些可能具有独特解剖结构、骨质流失、感染以及影响成功治疗方案选择的各种其他局部和全身因素的患者。医疗设备的三维（3-D）打印正为实现患者和外科医生保肢与重建的目标提供新的定制方法。
虽然大多数3-D打印是为植入目的而进行的，但我们介绍一种设计3-D打印模具的技术窍门，利用该模具制造用于植入的抗生素骨水泥间隔物。通过两个病例说明，包括距骨骨折不愈合和感染性距下关节融合不愈合，我们描述了患者选择、植入物设计、制造以及定制模制抗生素骨水泥距骨植入的过程。
病例说明展示了两名成功保肢的患者，同时对我们的技术、学到的技巧和窍门进行了全面解释。这项应用技术建立在先前在下肢保肢中使用抗生素骨水泥的基础上，其中大多数是牺牲关节的。为解剖型距骨骨水泥间隔物3-D打印模具可实现保肢且保留关节的解决方案。创新的3-D打印技术与当前有关抗生素骨水泥的相关文献相结合，为外科医生在一些最具挑战性的患者中提供了临时或确定性重建技术的更多选择。
