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.
Dengan memilah pasien lanjut usia dengan patah tulang pinggul yang didiagnosis dan dirawat oleh Departemen Trauma dan Ortopedi Rumah Sakit Jishuitan Beijing di masa lalu, tim Wakil Presiden Wu Xinbao dan Kepala Dokter Yang Minghui menemukan bahwa dengan meningkatnya pasien lanjut usia dengan patah tulang pinggul , jumlah penggantian pinggul buatan juga meningkat secara bertahap. Pasien tersebut juga berisiko tinggi mengalami cedera jatuh lebih lanjut, yang berarti bahwa fraktur femur periprostetik juga akan meningkat pada orang dewasa yang lebih tua. Perawatan fraktur periprostetik femoralis lanjut usia selalu menjadi masalah yang sulit bagi dokter ortopedi. Dalam perawatan, tiga aspek fraktur, prostesis, dan massa tulang harus diperhitungkan. Tidak peduli apa rencana perawatan yang diadopsi, perawatannya sangat sulit.
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.
Setelah dilakukan perencanaan pra operasi secara mendetail oleh tim perawatan, pada 12 Januari 2022, tim berhasil menyelesaikan reduksi dan fiksasi fraktur sesuai dengan desain bedah. Operasi memakan waktu 1 jam 45 menit dan kehilangan darah 400ml. Gambar pascaoperasi menunjukkan bahwa fraktur secara anatomis berkurang, pelat yang dibuat khusus -diposisikan dengan benar, dan penempatan kabel dan sekrup yang ideal, yang secara sempurna mencapai tujuan bedah dari perencanaan pra operasi.
Untuk pasien lanjut usia dengan osteoporosis dan morfologi situs fraktur khusus, terutama untuk pasien dengan fraktur yang terjadi di sekitar prostesis sendi buatan, reduksi yang baik dan fiksasi fraktur yang kuat merupakan prasyarat untuk penyembuhan fraktur dan pemulihan fungsi anggota tubuh yang terkena. Untuk pasien dengan anatomi abnormal pada lokasi fraktur, pelat baja konvensional tidak dapat mencapai perlekatan anatomis yang sempurna pada struktur lokasi fraktur. Penggunaan prostesis khusus dapat mencapai pengurangan fraktur yang nyaman, mengurangi sensasi benda asing pascaoperasi, dan meningkatkan fiksasi fraktur. dapat diandalkan.
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.
