Treatment of severe distal humeral bone defects with three-dimensional printing technology_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHAO Xing ^1,2 , YU Li ² , TAO Shengxiang ² , DENG Linglong ² , WEI Chi ² , WANG Bing ² ,  ZHU Shaobo ²

1. Department of Orthopedics, Taihe Hospital of Shiyan, Shiyan Hubei, 442000, P.R.China;
2. Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan Hubei, 430071, P.R.China;

Corresponding author：

ZHU Shaobo, Email: zhushaobo2000@163.com

Keywords：

Distal humeral bone defect; three-dimensional printing technology; personalized customization; arthroplasty

DOI：

10.7507/1002-1892.201803008

Video：

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ObjectiveTo explore the application of three-dimensional (3D) printing technology in precise and individualized surgical treatment of severe distal humeral bone defect.MethodsFive patients with severe distal humeral bone defects were treated with customized 3D printing prostheses between December 2010 and December 2015. There were 4 males and 1 female, with an age of 23-57 years (mean, 35 years); and the length of the bone defect was 5-12 cm (mean, 8 cm). The cause of injury was mechanical injury in 2 cases and strangulation in 3 cases. All of them were the open fracture of Gustilo type Ⅲ. There were 2 cases of radial fracture, 1 case of cubital nerve injury, and 3 cases of radial nerve injury. The time from injury to one-stage operation was 6-18 hours (mean, 10 hours). The operation time, intraoperative blood loss, and intraoperative fluoroscopy were recorded. During follow-up, the anteroposterior and lateral X-ray films of the elbow joints were performed to identify whether there was prosthesis loosening; Mayo Elbow Performance Score (MEPS) and upper extremity Enneking score were used to evaluate limb function.ResultsThe operation time was 140-190 minutes (mean, 165 minutes). The intraoperative blood loss was 310-490 mL (mean, 415 mL). The intraoperative fluoroscopy was 1-3 times (mean, 1.6 times). Five patients were followed up 14-38 months (mean, 21 months). The wound exudate occurred in 1 case and cured after anti-inflammatory local dressing change; the subcutaneous hematoma occurred in 1 case, and improved after color Doppler ultrasound guided puncture and drainage. The MEPS scores and the Enneking scores were all significantly improved when compared with preoperative ones (P<0.05). Except MEPS score between 6 and 12 months after operation had no significant difference (P>0.05), there were significant differences in MEPS scores and Enneking scores between the other time points (P<0.05). During the follow-up, no prosthetic loosening or joint dislocation occurred.Conclusion3D printing technology can achieve personalized treatment of severe distal humeral bone defects, obtain relatively good elbow joint function, and has less postoperative complications and satisfactory effectiveness.

Citation： ZHAO Xing, YU Li, TAO Shengxiang, DENG Linglong, WEI Chi, WANG Bing, ZHU Shaobo. Treatment of severe distal humeral bone defects with three-dimensional printing technology. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(12): 1534-1539. doi: 10.7507/1002-1892.201803008 Copy

1.	钟世镇, 方驰华. 三维打印技术的临床应用. 中华外科杂志, 2016, 54(9): 658-660.
2.	Krauel L, Fenollosa F, Riaza L, et al. Use of 3D prototypes for complex surgical oncologic cases. World J Surg, 2016, 40(4): 889-894.
3.	Shafiee A, Atala A. Printing technologies for medical applications. Trends Mol Med, 2016, 22(3): 254-265.
4.	麦奇光, 谷诚, 林学智, 等. 个性化金属三维打印髋臼翼形接骨板结合腹直肌外侧切口入路治疗复杂髋臼骨折. 中华外科杂志, 2017, 55(3): 172-178.
5.	曲龙, 施京辉, 刘黎亮, 等. 骨搬移法治疗骨感染、骨缺损及软组织缺损. 中华外科杂志, 2004, 42(23): 1469.
6.	Brydone AS, Meek D, Maclaine S. Bone grafting, orthopaedic biomaterials, and the clinical need for bone engineering. Proc Inst Mech Eng H, 2010, 224(12): 1329-1343.
7.	Chiarello E, Cadossi M, Tedesco G, et al. Autograft, allograft and bone substitutes in reconstructive orthopedic surgery. Aging Clin Exp Res, 2013, 25(Suppl 1): S101-S103.
8.	Friedrich MJ, Schmolders J, Lob G, et al. Intercalary reconstruction for diaphyseal bone defects with a modular replacement system: Clinical results. Oper Orthop Traumatol, 2015, 27(5): 455-462.
9.	Boos AM, Arkudas A, Kneser U, et al. Bone tissue engineering for bone defect therapy. Handchir Mikrochir Plast Chir, 2010, 42(6): 360-368.
10.	Giannoudis PV, Faour O, Goff T, et al. Masquelet technique for the treatment of bone defects: tips-tricks and future directions. Injury, 2011, 42(6): 591-598.
11.	Lee JH, Chung DW, Han CS. Outcomes of anterolateral thigh-free flaps and conversion from external to internal fixation with bone grafting in gustilo type ⅢB open tibial fractures. Microsurgery, 2012, 32(6): 431-437.
12.	Aurégan JC, Bégué T. Induced membrane for treatment of critical sized bone defect: a review of experimental and clinical experiences. Int Orthop, 2014, 38(9): 1971-1978.
13.	中华医学会医学工程学分会数字骨科学组. 3D 打印骨科模型技术标准专家共识. 中华创伤骨科杂志, 2017, 19(1): 61-64.
14.	Eltorai AE, Nguyen E, Daniels AH. Three-dimensional printing in orthopedic surgery. Orthopedics, 2015, 38(11): 684-687.
15.	Celik D. Psychometric properties of the Mayo Elbow Performance Score. Rheumatol Int, 2015, 35(6): 1015-1020.
16.	Wada T, Kawai A, Ihara K, et al. Construct validity of the Enneking score for measuring function in patients with malignant or aggressive benign tumours of the upper limb. J Bone Joint Surg (Br), 2007, 89(5): 659-663.
17.	刘兴炎, 葛宝丰, 甄平, 等. 肱骨远端难治性骨不连的修复. 中国修复重建外科杂志, 2005, 19(1): 52-53.
18.	Chalidis B, Dimitriou C, Papadopoulos P, et al. Total elbow arthroplasty for the treatment of insufficient distal humeral fractures. A retrospective clinical study and review of the literature. Injury, 2009, 40(6): 582-590.
19.	郭卫, 唐顺, 杨荣利, 等. 定制型人工肘关节重建肘部肿瘤切除后骨缺损. 中华外科杂志, 2008, 46(22): 1734-1737.
20.	何方舟, 张伟滨, 沈宇辉. 定制型限制性全肘关节假体置换 8 例报告. 上海交通大学学报 (医学版), 2016, 36(8): 1205-1209.
21.	郭卫, 王毅飞, 张熠丹, 等. 3D 打印组配式骨盆假体重建骨盆肿瘤切除后骨缺损. 中华骨科杂志, 2016, 36(20): 1302-1311.
22.	裴延军, 吴智钢. 西京医院骨科完成亚洲首例 3d 打印钛合金骨盆假体植入术. 中华创伤骨科杂志, 2014, 16(5): 后插 7.
23.	裴延军, 吴智钢. 世界首例 3D 打印钛合金锁骨和肩胛骨植入手术在西京医院成功实施. 中华创伤骨科杂志, 2014, 16(5): 后插 6.
24.	仰东萍, 姚永玲. 北京大学第三医院完成中国首例 3D 打印脊椎手术. 中华医学信息导报, 2016, (14): 6.
25.	叶堃, 王金武, 胡志刚, 等. 3D 打印钛合金个性化骨盆假体生物力学的初步有限元分析. 中华创伤骨科杂志, 2015, 17(1): 18-22.

1. 钟世镇, 方驰华. 三维打印技术的临床应用. 中华外科杂志, 2016, 54(9): 658-660.
2. Krauel L, Fenollosa F, Riaza L, et al. Use of 3D prototypes for complex surgical oncologic cases. World J Surg, 2016, 40(4): 889-894.
3. Shafiee A, Atala A. Printing technologies for medical applications. Trends Mol Med, 2016, 22(3): 254-265.
4. 麦奇光, 谷诚, 林学智, 等. 个性化金属三维打印髋臼翼形接骨板结合腹直肌外侧切口入路治疗复杂髋臼骨折. 中华外科杂志, 2017, 55(3): 172-178.
5. 曲龙, 施京辉, 刘黎亮, 等. 骨搬移法治疗骨感染、骨缺损及软组织缺损. 中华外科杂志, 2004, 42(23): 1469.
6. Brydone AS, Meek D, Maclaine S. Bone grafting, orthopaedic biomaterials, and the clinical need for bone engineering. Proc Inst Mech Eng H, 2010, 224(12): 1329-1343.
7. Chiarello E, Cadossi M, Tedesco G, et al. Autograft, allograft and bone substitutes in reconstructive orthopedic surgery. Aging Clin Exp Res, 2013, 25(Suppl 1): S101-S103.
8. Friedrich MJ, Schmolders J, Lob G, et al. Intercalary reconstruction for diaphyseal bone defects with a modular replacement system: Clinical results. Oper Orthop Traumatol, 2015, 27(5): 455-462.
9. Boos AM, Arkudas A, Kneser U, et al. Bone tissue engineering for bone defect therapy. Handchir Mikrochir Plast Chir, 2010, 42(6): 360-368.
10. Giannoudis PV, Faour O, Goff T, et al. Masquelet technique for the treatment of bone defects: tips-tricks and future directions. Injury, 2011, 42(6): 591-598.
11. Lee JH, Chung DW, Han CS. Outcomes of anterolateral thigh-free flaps and conversion from external to internal fixation with bone grafting in gustilo type ⅢB open tibial fractures. Microsurgery, 2012, 32(6): 431-437.
12. Aurégan JC, Bégué T. Induced membrane for treatment of critical sized bone defect: a review of experimental and clinical experiences. Int Orthop, 2014, 38(9): 1971-1978.
13. 中华医学会医学工程学分会数字骨科学组. 3D 打印骨科模型技术标准专家共识. 中华创伤骨科杂志, 2017, 19(1): 61-64.
14. Eltorai AE, Nguyen E, Daniels AH. Three-dimensional printing in orthopedic surgery. Orthopedics, 2015, 38(11): 684-687.
15. Celik D. Psychometric properties of the Mayo Elbow Performance Score. Rheumatol Int, 2015, 35(6): 1015-1020.
16. Wada T, Kawai A, Ihara K, et al. Construct validity of the Enneking score for measuring function in patients with malignant or aggressive benign tumours of the upper limb. J Bone Joint Surg (Br), 2007, 89(5): 659-663.
17. 刘兴炎, 葛宝丰, 甄平, 等. 肱骨远端难治性骨不连的修复. 中国修复重建外科杂志, 2005, 19(1): 52-53.
18. Chalidis B, Dimitriou C, Papadopoulos P, et al. Total elbow arthroplasty for the treatment of insufficient distal humeral fractures. A retrospective clinical study and review of the literature. Injury, 2009, 40(6): 582-590.
19. 郭卫, 唐顺, 杨荣利, 等. 定制型人工肘关节重建肘部肿瘤切除后骨缺损. 中华外科杂志, 2008, 46(22): 1734-1737.
20. 何方舟, 张伟滨, 沈宇辉. 定制型限制性全肘关节假体置换 8 例报告. 上海交通大学学报 (医学版), 2016, 36(8): 1205-1209.
21. 郭卫, 王毅飞, 张熠丹, 等. 3D 打印组配式骨盆假体重建骨盆肿瘤切除后骨缺损. 中华骨科杂志, 2016, 36(20): 1302-1311.
22. 裴延军, 吴智钢. 西京医院骨科完成亚洲首例 3d 打印钛合金骨盆假体植入术. 中华创伤骨科杂志, 2014, 16(5): 后插 7.
23. 裴延军, 吴智钢. 世界首例 3D 打印钛合金锁骨和肩胛骨植入手术在西京医院成功实施. 中华创伤骨科杂志, 2014, 16(5): 后插 6.
24. 仰东萍, 姚永玲. 北京大学第三医院完成中国首例 3D 打印脊椎手术. 中华医学信息导报, 2016, (14): 6.
25. 叶堃, 王金武, 胡志刚, 等. 3D 打印钛合金个性化骨盆假体生物力学的初步有限元分析. 中华创伤骨科杂志, 2015, 17(1): 18-22.

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