摘要
背景:现代工业手外伤类型向软组织与骨关节小型缺损转变,自体足趾关节移植仍是修复手指小关节创伤性缺损最常用的方法。目的:探讨模拟自体足趾关节移植修复手指小关节缺损手术的数字试验方法,并通过3D打印导航技术实现小关节的精准重建。方法:13例13指近侧指间关节缺损纳入研究,按计划实施同侧第2趾带血管蒂的骨关节皮瓣游离移植修复手指近侧指间关节缺损,按执行过程分为数字化设计组及现实手术组。所有患者对治疗方案均知情同意,且得到医院伦理委员会批准。数字化设计组进行数字模拟手术,手术结果经虚拟X射线测量近中节指骨轴长、近侧指间关节关节面倾斜度、旋转轴心偏移等参数。现实手术组在数字设计指导下进行手术,经"相互适应"原则设定基准截骨平面,制作截骨导航模块并3D打印成型,对指、趾骨进行精准截骨,按计划进行关节移植、固定、血管吻合等。现实手术组术后CT结果经虚拟X射线测量各形态学参数,采用配对样本t检验与数字化设计组比较,检测数字设计与现实手术效果的一致性。结果与结论:(1)13例13指骨皮瓣移植术后全部成活、骨愈合;(2)术后近侧指间关节关节活动度为(55.0±14.0)°,伸直受限(18.5±9.0)°,关节总体活动度优良率为84.6%;(3)t检验比较数字化设计组与现实手术组近节指骨轴长、中节指骨轴长、近侧指间关节关节面倾斜度、旋转轴心偏移,差异均无显著性意义(P> 0.05);比较重建指与术前第2趾相应关节面倾斜度,差异有显著性意义(P <0.05);(4)提示数字化设计中遵循"相互适应"原则,有利于重建关节获得最佳形态与愈合机会。而通过3D打印导航的现实手术可获得与数字化设计基本一致的关节形态,从而实现手指小关节的精准重建,达到更佳的关节活动功能。
BACKGROUND: The types of hand injuries in modern industry have changed to small defects of soft tissue, bone or joint. Autogenous toe joint transplantation is still the most commonly method to repair the traumatic defect of the digital joint.OBJECTIVE: To investigate the surgical process of repairing the hand facet joint defect by digital experiment simulation with toe joint flap transplantation, and to realize the accurate interception and reconstruction of the transplanted joint through 3 D printing navigation module.METHODS: Totally 13 cases with proximal interphalangeal joint defect(13 fingers) were included in this clinical study. Proximal interphalangeal joint defect of finger was repaired by free transplantation of vascularized osteoarthrocutaneous flaps of the ipsilateral second toe as planned. The implementation process was divided into digital design group and realistic surgery group. All patients signed informed consent. This study was approved by the Hospital Ethics Committee. Digital design group was implemented with digital simulation surgery.Virtual X-ray was used to measure parameters such as the axial length of the proximal middle phalanx, the inclination of proximal interphalangeal joint surface, and the rotation axis deviation. With the help of the coadapted reference osteotomy plane in digital design group,the navigation module of digital and phalangeal osteotomy was made and 3 D printed into a solid tool. 3 D printed osteotomy navigation was used in realistic surgery group to perform accurate osteotomy of finger and phalanges, and carries out joint transplantation, fixation and vascular anastomosis as planned. Postoperative CT scans were carried in realistic surgery group and the morphological parameters were measured using the virtual X-ray. Paired t-test was used to compare the postoperative morphological parameters of realistic surgery group with the digital design group.RESULTS AND CONCLUSION:(1) All the 13 fingers of 13 cases survived and achieved bone healing after bone flap transplantation.(2)Postoperative proximal interphalangeal joint range of motion was(55.0±14.0)°;straightening limitation was(18.5±9.0)°;excellent and good rate of total range of motion of joints was 84.6%.(3) Paired t-test results showed that there was no significant difference in proximal phalanx axial length, middle phalanx axial length, proximal interphalangeal joint surface inclination, and rotation axis deviation between the digital design group and realistic surgery group(P > 0.05). The inclination of the reconstructive finger and the joint surface of the second toe before surgery was significantly different(P < 0.05).(4) The principle of "Coadaptation" in digital design is advantageous to obtaining the best morphology and healing opportunity of reconstructed joints. By 3 D printing-navigation, the digital design of morphology can be basically consistent in the actual operation, realizing the precise reconstruction of the digital joint and achieving better joint motion function.
作者
何藻鹏
许靖
张国栋
韦春荣
廖贤万
李卫
黄文华
He Zaopeng;Xu Jing;Zhang Guodong;Wei Chunrong;Liao Xianwan;Li Wei;Huang Wenhua(Deparment of Hand and FootSurgery,Shunde Hospital Affiliated to Guangzhou Medical University,Foshan 528315,Guangdong Province,China;Guangdong Medical 3D Printing Application and Transformation Engineering Technology Research Center,Guangzhou 510515,Guangdong Province,China;Department of Orthopedics,Affilicated Putian Hospital of Southern Medical University,Putian 351100,Fujian Province,China)
出处
《中国组织工程研究》
CAS
北大核心
2019年第31期4932-4938,共7页
Chinese Journal of Tissue Engineering Research
基金
广东省医学3D打印应用转化工程技术研究中心开放基金(K20180401):精准重建手部小关节缺损的应用解剖与数字化技术研究,项目负责人:何藻鹏
广东省科技发展专项基金(2016B090917001):面向3D打印的数字医学技术支持中心建设及应用示范,项目负责人:黄文华
佛山市科技局医学类科技攻关项目(2018AB002323):基于3D打印技术的跖趾关节移植个性化修复手部小关节部分缺损的基础研究与临床应用,项目负责人:何藻鹏
佛山市医学科技创新平台项目(2017AG100243):广东省医学3D打印应用转化工程技术研究中心顺德基地,项目负责人:李卫~~
关键词
近侧指间关节缺损
足趾移植
3D打印
数字化
相互适应
proximal interphalangeal joint defect
toe transplantation
3D printing
digital
coadaptation
