3D打印个体化定制钢板固定治疗老年股骨假体周围骨折的近期疗效分析北大核心CSCD

目的探讨3D打印个体化定制钢板固定治疗老年股骨假体周围骨折的近期疗效。方法回顾性分析2022年1月至7月期间北京积水潭医院创伤骨科采用3D打印个体化定制钢板固定治疗的5例老年股骨假体周围骨折患者资料。男3例,女2例;年龄分别为81、86、77、91、87岁;左侧1例,右侧4例。骨折Vancouver分型:B1型3例,B2型1例,C型1例。受伤至手术时间分别为5、6、10、5、7 d。术前采用3D打印技术1∶1模型定制具有大转子钩、环扎线缆通道及类骨小梁微孔结构的个体化钢板、患侧股骨与关节假体,虚拟术中操作并制定手术计划。记录患者的手术时间、手术切口长度、术中失血量及输血量、住院时间、末次随访时患髋功能及并发症发生情况等。结果5例患者术后分别获12、7、10、3、6个月随访。随访期间所有患者未发生切口浅表及假体深部感染。5例患者手术时间分别为1.8、1.7、2.3、2.0、3.3 h,手术切口长度分别为31、30、38、27、30 cm,术中失血量分别为400、300、300、500、600 mL,住院时间分别为8、9、15、14、11 d。4例患者术中输血,输血量分别为300、900、150、1050 mL。1例患者出院后3个月因心脏疾病而死亡;1例患者出院后3个月因脑梗死出现对侧肢体活动不利,术后7个月因再发脑梗死而死亡。末次随访时3例患者髋关节Harris评分分别为86、77、69分。所有患者无内固定物断裂或松动等并发症发生。结论3D打印个体化定制钢板固定治疗老年股骨假体周围骨折可获得良好的肢体功能,近期疗效较好。

Fixation with a 3D printed individualized custom-made plate for elderly patients with periprosthetic femoral fracture: an analysis of short-term efficacy

Objective To explore the short-term efficacy of fixation with a 3D printed individualized custom-made plate in the treatment of elderly patients with periprosthetic femoral fracture. Methods Retrospectively analyzed were the 5 elderly patients with periprosthetic femoral fracture who had been treated by fixation with a 3D printed individualized custom-made plate from January 2022 to July 2022 at Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital. There were 3 males and 2 females, aged 81, 86, 77, 91 and 87 years, respectively. One left and 4 right limbs were affected. Vancouver classification: type Bl (n = 3), type B2 (n = 1), and type C (n = 1). The time from operation to injury was 5, 6, 10, 5 and 7 days, respectively. Preoperatively, the femur affected, prosthesis and individualized plate with a greater trochanteric hook, loop cable channel and bone-like trabecular microporous structure were custom-made by 3D printing according to 1: 1 models. Virtual operations were simulated to formulate surgical protocols. The operation time, length of surgical incision, intraoperative blood loss and transfusion, hospital stay, hip function and complications at the last follow-up were recorded. Results The 5 patients were followed up for 12, 7, 10, 3 and 6 months, respectively. There were no events of superficial incision or deep prosthesis infection. Respectively, the operation time was 1. 8, 1.7, 2.3, 2. 0 and 3.3 h; the length of surgical incision 31, 30, 38, 27 and 30 cm; the intraoperative bleeding volume 400, 300, 300, 500 and 600 mL; the length of hospital stay 8, 9, 15, 14 and 11 d. Four patients received intraoperative blood transfusion of 300, 900, 150 and 1, 050 mL, respectively. One patient died of a heart attack 3 months after discharge; another patient developed dyskinesia at the contralateral limb 3 months after discharge due to cerebral infarction and died of recurrent cerebral infarction 7 months after discharge. At the last follow-up, the Harris hip scores of 3 patients were 86, 77 and 69 points, respectively. None of the patients had complications like breakage or loosening of implants. Conclusion In the treatment of elderly patients with periprosthetic femoral fracture, fixation with a 3D printed individualized custom-made plate may lead to fine limb function and good short-term curative efficacy. © 2023 Chinese Medical Journals Publishing House Co.Ltd. All rights reserved.