背景:胫骨骨干严重骨缺损(CBD)的临床修复面临许多挑战,包括软组织覆盖不足,有限的血液供应,高承重要求,和潜在的畸形。本研究旨在探讨使用3D打印假体修复胫骨干超过10厘米的CBD的临床可行性和有效性。
方法:这项回顾性研究包括14例患者(11例男性和3例女性),平均年龄为46.0岁。CBDs的病因包括慢性骨髓炎(10例)和无菌性骨不愈合(4例)。平均缺陷长度为16.9厘米。所有患者均行两阶段手术:(1)清创,截骨,和水泥垫片植入;和(2)插入3D打印假体。两个阶段之间的间隔为8到12周,在此期间,精心准备了3D打印的假体和诱导膜。手术后,在专业监督下进行负重和功能锻炼的患者。后续评估,包括粗略的观察,影像学检查,和下肢功能量表(LEFS)的管理,在术后3、6和12个月进行,此后进行年度评估。
结果:术后平均随访时间为28.4个月,假体植入和负重之间的平均等待时间为10.4天。在最新的后续行动中,所有患者在没有帮助的情况下表现出自主行走,他们的LEFS评分与术前值相比有显著改善(30.7vs.53.1,P<0.001)。影像学评估显示缺损部位进行性骨再生,新的骨骼形成沿着假体延伸。并发症包括两名患者的互锁螺钉断裂,一名患者的互锁螺钉松动,和指甲断裂在另一个。
结论:使用3D打印的假体有助于胫骨骨干迅速恢复CBD,使负重活动的早期开始和步行功能的恢复。这种有效的手术方法有望实际应用。
BACKGROUND: Clinical repair of critical-sized bone defects (CBDs) in the tibial diaphysis presents numerous challenges, including inadequate soft tissue coverage, limited blood supply, high load-bearing demands, and potential deformities. This study aimed to investigate the clinical feasibility and efficacy of employing 3D-printed prostheses for repairing CBDs exceeding 10 cm in the tibial diaphysis.
METHODS: This retrospective study included 14 patients (11 males and 3 females) with an average age of 46.0 years. The etiologies of CBDs comprised chronic osteomyelitis (10 cases) and aseptic non-union (4 cases), with an average defect length of 16.9 cm. All patients underwent a two-stage surgical approach: (1) debridement, osteotomy, and cement spacer implantation; and (2) insertion of 3D-printed prostheses. The interval between the two stages ranged from 8 to 12 weeks, during which the 3D-printed prostheses and induced membranes were meticulously prepared. Subsequent to surgery, patients engaged in weight-bearing and functional exercises under specialized supervision. Follow-up assessments, including gross observation, imaging examinations, and administration of the Lower Extremity Functional Scale (LEFS), were conducted at 3, 6, and 12 months postoperatively, followed by annual evaluations thereafter.
RESULTS: The mean postoperative follow-up duration was 28.4 months, with an average waiting period between prosthesis implantation and weight-bearing of 10.4 days. At the latest follow-up, all patients demonstrated autonomous ambulation without assistance, and their LEFS scores exhibited a significant improvement compared to preoperative values (30.7 vs. 53.1, P < 0.001). Imaging assessments revealed progressive bone regeneration at the defect site, with new bone formation extending along the prosthesis. Complications included interlocking screw breakage in two patients, interlocking screw loosening in one patient, and nail breakage in another.
CONCLUSIONS: Utilization of 3D-printed prostheses facilitates prompt restoration of CBDs in the tibial diaphysis, enabling early initiation of weight-bearing activities and recovery of ambulatory function. This efficacious surgical approach holds promise for practical application.