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.
Z razvrščanjem starejših bolnikov z zlomi kolka, ki so jih v preteklosti diagnosticirali in zdravili na Oddelku za travmo in ortopedijo pekinške bolnišnice Jishuitan, je ekipa podpredsednika Wuja Xinbaoa in glavnega zdravnika Yanga Minghuija ugotovila, da je s povečanjem števila starejših bolnikov z zlomi kolka , se je postopoma povečevalo tudi število zamenjav umetnih kolkov. Takšni bolniki imajo tudi veliko tveganje za nadaljnje poškodbe pri padcu, kar pomeni, da se bodo periprostetični zlomi stegnenice povečali tudi pri starejših odraslih. Zdravljenje tovrstnih periprostetičnih zlomov stegnenice pri starejših je bilo za zdravnike ortopede vedno težaven problem. Pri zdravljenju je treba upoštevati tri vidike zloma, proteze in kostne mase. Ne glede na to, kakšen načrt zdravljenja je sprejet, je zdravljenje zelo težko.
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.
Po podrobnem predoperativnem načrtovanju s strani terapevtske ekipe je ekipa 12. januarja 2022 uspešno zaključila redukcijo in fiksacijo zloma po kirurški zasnovi. Operacija je trajala 1 uro in 45 minut, izguba krvi pa je bila 400 ml. Pooperativne slike so pokazale, da je bil zlom anatomsko zmanjšan, po meri narejena-plošča pravilno nameščena, serklaža kabla in postavitev vijaka sta bila idealna, kar je odlično doseglo kirurške cilje predoperativnega načrtovanja.
Pri starejših bolnikih z osteoporozo in posebno morfologijo mesta zloma, zlasti pri bolnikih z zlomi, ki nastanejo okoli umetnih sklepnih protez, sta dobra redukcija in trdna fiksacija zloma predpogoj za celjenje zloma in ponovno vzpostavitev funkcije prizadete okončine. Pri bolnikih z nenormalno anatomijo mesta zloma običajne jeklene plošče ne morejo doseči popolne anatomske pritrditve na strukturo mesta zloma. Z uporabo prilagojenih protez lahko dosežete priročno zmanjšanje zloma, zmanjšate pooperativni občutek tujega telesa in izboljšate fiksacijo zloma. zanesljiv.
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.
