切换至 "中华医学电子期刊资源库"

中华肩肘外科电子杂志 ›› 2024, Vol. 12 ›› Issue (03) : 257 -261. doi: 10.3877/cma.j.issn.2095-5790.2024.03.009

病例报告

3D打印指导下自体髂骨结构性植骨联合内固定术治疗肱骨远端陈旧骨缺损一例病案报道
王陶然1, 高嘉锴1,(), 毕龙1, 吴尧平1, 牛志霞1, 宋晨1   
  1. 1. 710032 空军军医大学西京医院创伤骨科
  • 收稿日期:2023-06-25 出版日期:2024-08-05
  • 通信作者: 高嘉锴
  • Received:2023-06-25 Published:2024-08-05
引用本文:

王陶然, 高嘉锴, 毕龙, 吴尧平, 牛志霞, 宋晨. 3D打印指导下自体髂骨结构性植骨联合内固定术治疗肱骨远端陈旧骨缺损一例病案报道[J]. 中华肩肘外科电子杂志, 2024, 12(03): 257-261.

肱骨远端骨折在肘部创伤中较为常见,约占全身骨折的4%,较大的肱骨远端应力可导致骨质缺损,加之肘关节解剖结构较为复杂,治疗不当势必影响到关节功能[1]。对于肱骨远端骨折不愈合患者,尤其存在骨缺损患者,治疗更为困难,治疗不当预后不良。空军军医大学第一附属医院创伤骨科于2022年6月收治1例男性患者,因外伤后导致肱骨远端粉碎骨折,外院手术后1年复查发现肱骨远端陈旧骨缺损,收入本院后给予3D打印指导下自体髂骨结构性植骨联合内固定术治疗。现报道如下:

图1 外院术前正侧位X线片
图2 外院于伤后9 d行开放复位内固定,术后发现复位不良(图A,仅有正位);并于3 d后行鹰嘴截骨、肱骨远端骨折调整术,并植入同种异体骨(图B)
图3 外院术后1年复查正侧位X线片
图4 肱骨滑车骨质吸收、骨缺损明显,螺钉切入关节,滑车切迹关节面磨损严重
图5 本院翻修术前功能状态:肘关节屈伸活动100~130°(图A-B),旋前40°(图C),旋后80°(图D),且肘关节活动时摩擦感明显,Mayo评分:45分
图6 通过肘关节后侧入路,将肱三头肌自内向外翻转(图A),取出原内固定后在3D打印指导下测量确认骨质缺损范围(约2 cm×3 cm×5 cm)(图B),取髂骨板仔细修剪雕刻打磨后置于骨缺损处,重建肱骨滑车(图C),恢复肘关节形态。使用内外侧双钢板妥善固定(图D),透视确认内固定位置满意,髂骨植骨满意(图E)
图7 术后复查正侧位X线片
图8 术后第2天即开始肘关节功能活动,肘关节屈伸活动改善
图9 翻修术后3个月复查,功能状态改善明显
图10 翻修术后1年复查,骨折愈合良好(图A);功能恢复良好,Mayo评分:90分(图B)
[1]
Nouraei M, Motififar M, Barazandeh M. Evaluation of Outcomes of Open Reduction and Internal Fixation Surgery in Patients with Type C Distal Humeral Fractures[J]. Adv Biomed Res,2018,7:3.
[2]
Dido Ym, Dulo OA. Dynamic Of Upper Limb Sensorimotor Recovery Assessed On The Fugl-Meyer Scale In Post-Stroke Patients With Neglect Syndrome Receiving Combined Physical Therapy And Ergotherapy[J]. Wiad Lek,2021,74(4):849-855.
[3]
Baessler A, Eason RR, Joyce MR, et al. Reliability Testing of the Mayo Elbow Performance Score in Post-operative Patients[J]. J Surg Orthop Adv,2022,31(4):229-232.
[4]
Donders J, Lorich DG, Helfet DL, et al. Surgical Technique: Treatment of Distal Humerus Nonunions[J]. HSS J,2017,13(3):282-291.
[5]
Yetter TR, Weatherby PJ, Somerson JS. Complications of articular distal humeral fracture fixation: a systematic review and meta-analysis[J]. J Shoulder Elbow Surg,2021,30(8):1957-1967.
[6]
Wilfred AM, Akhter S, Horner NS, et al. Outcomes and complications of distal humeral hemiarthroplasty for distal humeral fractures —— A systematic review[J]. Shoulder Elbow,2022,14(1):65-74.
[7]
郭卫,梁海杰,杨毅,等.3D打印半肘关节假体重建肱骨远端骨缺损的早期临床疗效[J].中华骨与关节外科杂志,2022,15(7):524-531.
[8]
Henrichs MP, Liem D, Gosheger G, et al. Megaprosthetic replacement of the distal humerus: still a challenge in limb salvage[J]. J Shoulder Elbow Surg,2019,28(5):908-914.
[9]
Armangil M, Bilgin SS. Reconstruction of Proximal Humeral Defects with Shoulder Arthrodesis Using Free Vascularized Fibular Graft: Surgical Technique[J]. JBJS Essent Surg Tech,2014,3(2):e8.
[10]
Giannoudis PV, Al-Lami MK, Tzioupis C, et al. Tricortical bone graft for primary reconstruction of comminuted distal humerus fractures[J]. J Orthop Trauma,2005,19(10):741-743.
[11]
Zha Y, Hua K, Gong M, et al. Chronic type C3 distal humeral fracture associated with massive bone defects treated by open reduction and internal fixation with iliac crest autografts: a case report[J]. BMC Musculoskelet Disord,2021,22(1):338.
[12]
Ring D, Jupiter JB. Operative treatment of osteochondral nonunion of the distal humerus[J]. J Orthop Trauma,2006,20(1):56-59.
[13]
Niu Y, Bai Y, Xu S, et al. Treatment of bone nonunion and bone defects associated with unsuccessful humeral condylar fracture repair with autogenous iliac bone reconstruction[J]. J Shoulder Elbow Surg,2012,21(8):985-991.
No related articles found!
阅读次数
全文


摘要