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.
Ved at sortere de ældre patienter med hoftebrud diagnosticeret og behandlet af Department of Trauma and Orthopaetics of Beijing Jishuitan Hospital i fortiden, fandt teamet af vicepræsident Wu Xinbao og overlæge Yang Minghui, at med stigningen i antallet af ældre patienter med hoftebrud , er antallet af kunstige hofteudskiftninger også gradvist steget. Sådanne patienter har også høj risiko for yderligere faldskade, hvilket betyder, at periprostetiske lårbensfrakturer også vil øges hos ældre voksne. Behandlingen af sådanne ældre periprostetiske lårbensfrakturer har altid været et vanskeligt problem for ortopædiske læger. I behandlingen skal der tages højde for tre aspekter af fraktur, protese og knoglemasse. Uanset hvilken behandlingsplan der er vedtaget, er behandlingen meget vanskelig.
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.
Efter detaljeret præoperativ planlægning af behandlingsteamet gennemførte teamet den 12. januar 2022 reduktionen og fikseringen af frakturen i henhold til det kirurgiske design. Operationen tog 1 time og 45 minutter og blodtabet var 400ml. Postoperative billeder viste, at bruddet var anatomisk reduceret, den specialfremstillede-plade var placeret korrekt, og kabelskruen og skrueplaceringen var ideel, hvilket perfekt nåede de kirurgiske mål for præoperativ planlægning.
For ældre patienter med osteoporose og særlig brudstedsmorfologi, især for patienter med brud, der opstår omkring kunstige ledproteser, er god reduktion og fast fiksering af bruddet forudsætningen for brudheling og genopretning af funktionen af det berørte lem. For patienter med unormal anatomi af frakturstedet kan konventionelle stålplader ikke opnå perfekt anatomisk fastgørelse til frakturstedets struktur. Brugen af skræddersyede proteser kan opnå bekvem frakturreduktion, reducere postoperativ fremmedlegemefornemmelse og forbedre frakturfikseringen. pålidelig.
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.
