Qiu Weipeng, Liu Bingchuan, Li Xingcai, Tian Yun
Department of Orthopaedics, Peking University Third Hospital, Beijing, China.
Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China.
Ann Transl Med. 2022 Aug;10(15):840. doi: 10.21037/atm-22-447.
Nonunion of the humeral shaft can turn into bone defects. There is no consensus on the optimal treatment of humeral shaft nonunion with bone defects. Herein, we presented a single case of a patient with a 9.5 cm humerus shaft bone defect treated with a 3D printed TiAlV microporous prosthesis after internal fixation failure of a middle-inferior humerus fracture.
A 53-year-old female who injured her left upper limb by falling was diagnosed with a fracture of the left humeral shaft. The fracture was treated with open reduction and internal fixation. Nine months postoperatively, radiography examination indicated humeral nonunion with a 9.5 cm segmental bone defect. A 3D printing technology was then used to design and fabricate a customized microporous prosthesis with an intramedullary nail and lateral plates. A two-stage surgical strategy was performed, including radical debridement, temporary fixation for the induced membrane formation, and the implantation of the prosthesis. At 18 months of follow-up, encouraging clinical outcomes were observed. The prosthesis remained stable in the original implantation area and callus formation was found at the contact end of the prosthesis and bone stump. The upper limb functions returned to normal with a satisfactory functional score. Also, no complications were found.
Reconstruction with a 3D printed microporous prosthesis might be used as an alternative for the repair of large segmental bone defects of limbs.
肱骨干骨不连可发展为骨缺损。对于肱骨干骨不连合并骨缺损的最佳治疗方法尚无共识。在此，我们报告了一例肱骨干骨缺损9.5厘米的患者，在肱骨干中下骨折内固定失败后，采用3D打印的TiAlV微孔假体进行治疗。
一名53岁女性因摔倒致左上肢受伤，被诊断为左肱骨干骨折。骨折采用切开复位内固定治疗。术后9个月，影像学检查显示肱骨干骨不连，伴有9.5厘米的节段性骨缺损。随后采用3D打印技术设计并制造了一种定制的带髓内钉和侧板的微孔假体。采用两阶段手术策略，包括彻底清创、诱导膜形成的临时固定以及假体植入。随访18个月时，观察到了令人鼓舞的临床结果。假体在原植入部位保持稳定，在假体与骨残端的接触端发现有骨痂形成。上肢功能恢复正常，功能评分满意。此外，未发现并发症。
3D打印微孔假体重建可作为修复四肢大段骨缺损的一种替代方法。
