The patient, an 81-year-old woman, was hospitalized in the Department of Geriatric Trauma and Orthopedics of Jishuitan Hospital because of a fall on her right hip. In particular, the patient was diagnosed with a right femoral neck fracture 7 years ago due to his right hip landing after a fall. This fracture is also known as the "last fracture of life" in the elderly, and the mortality and disability after the fracture are high. The rate is very high. The old man underwent artificial femoral head replacement at that time, and he quickly recovered to a normal life after the operation. He walked freely for 7 years. Unfortunately, the patient suffered a second fall injury that resulted in a periprosthetic fracture of the right femur, which was more complicated, more difficult to treat, and more operative than the previous one.
Ao classificar os pacientes idosos com fraturas de quadril diagnosticados e tratados pelo Departamento de Trauma e Ortopedia do Hospital Jishuitan de Pequim no passado, a equipe do vice-presidente Wu Xinbao e o médico chefe Yang Minghui descobriram que, com o aumento de pacientes idosos com fraturas de quadril , o número de substituições artificiais de quadril também aumentou gradualmente. Esses pacientes também estão em alto risco de lesões adicionais por queda, o que significa que as fraturas femorais periprotéticas também aumentarão em adultos mais velhos. O tratamento dessas fraturas periprotéticas do fêmur em idosos sempre foi um problema difícil para os médicos ortopedistas. No tratamento, três aspectos de fratura, prótese e massa óssea devem ser levados em consideração. Não importa qual plano de tratamento seja adotado, o tratamento é muito difícil.
For this elderly man with secondary fragility orthopedics, the treatment team considered that most of the current periprosthetic fracture plates do not match the shape of the patient's proximal femur and cannot be well attached to the surface of the proximal femur, which is likely to cause metal objects to irritate the surrounding soft tissue. It will affect the recovery of limb function after surgery. In addition, the presence of the prosthesis prevents the placement of screws at the proximal end of the plate, and there is no dedicated channel for cable cerclage on the plate, resulting in unstable fracture fixation and failure of the internal fixator in the long-term. It would be a disastrous outcome for the elderly with subfragile fractures.
Therefore, through a comprehensive analysis of the patient's condition, the treatment team decided to adopt the 3D printing technology that is currently at the forefront of orthopedic treatment. The traditional 3D printing custom steel plate is just a 3D printing of the femur model, and then the customized steel plate is processed by the machine tool. Through the medical-engineering interaction system of AK Medical, the RD engineer team closely cooperates with the team of Professor Wu Xinbao. According to the image data of the patient's affected limb, a specially designed The anatomical femoral periprosthetic plate is made by custom-made metal 3D printing technology. The customized plate uses an innovative design. Morphologically, the hook-like structure at the proximal end of the plate can fit perfectly with the patient's major trochanter. The plate has specially made a channel for the cerclage cable in the femoral prosthesis segment, which makes the operation easier. It is simple and convenient, and the plate is designed with 4 screw holes in the distal part of the prosthesis for the placement of bicortical screws. The stable fracture fixation ability of the whole customized plate system, the anatomical shape design for easy reduction and fixation, and the precise functions of the trochanteric hook and the proximal cerclage channel form a fracture internal fixation system that integrates three major advantages. , so as to avoid the deficiencies of traditional internal fixators, and at the same time take into account the needs of periprosthetic fractures, prosthesis and insufficient bone mass, increase the strength of internal fixation for fractures, and more reliably ensure the clinical treatment goal of fracture healing.
Após planejamento pré-operatório detalhado pela equipe de tratamento, em 12 de janeiro de 2022, a equipe concluiu com sucesso a redução e fixação da fratura de acordo com o desenho cirúrgico. A operação durou 1 hora e 45 minutos e a perda sanguínea foi de 400ml. As imagens pós-operatórias mostraram que a fratura foi anatomicamente reduzida, a placa-feita sob medida foi posicionada adequadamente e a cerclagem do cabo e a colocação do parafuso foram ideais, o que atingiu perfeitamente os objetivos cirúrgicos do planejamento pré-operatório.
Para pacientes idosos com osteoporose e morfologia especial do local da fratura, especialmente para pacientes com fraturas que ocorrem ao redor de próteses articulares artificiais, uma boa redução e fixação firme da fratura são os pré-requisitos para a consolidação da fratura e restauração da função do membro afetado. Para pacientes com anatomia anormal do local da fratura, as placas de aço convencionais não conseguem uma fixação anatômica perfeita à estrutura do local da fratura. O uso de próteses personalizadas pode alcançar a redução conveniente da fratura, reduzir a sensação pós-operatória de corpo estranho e melhorar a fixação da fratura. de confiança.
At present, "3D printing customized surgical technology" has become one of the effective treatment methods for specific groups of people, which can greatly reduce the complications caused by insufficient traditional treatment methods, and can provide patients with more effective clinical treatment effects. However, this technology also has shortcomings such as a slightly longer waiting time for printing and a lack of special surgical tools, which needs to be further improved in clinical practice.
