Treatment of severe distal humeral bone defects with three-dimensional printing technology_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHAO Xing ^1,2 , YU Li ² , TAO Shengxiang ² , DENG Linglong ² , WEI Chi ² , WANG Bing ² ,  ZHU Shaobo ²

1. Department of Orthopedics, Taihe Hospital of Shiyan, Shiyan Hubei, 442000, P.R.China;
2. Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan Hubei, 430071, P.R.China;

Corresponding?author：

ZHU Shaobo, Email: zhushaobo2000@163.com

Keywords：

Distal humeral bone defect; three-dimensional printing technology; personalized customization; arthroplasty

DOI：

10.7507/1002-1892.201803008

Video：

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ObjectiveTo explore the application of three-dimensional (3D) printing technology in precise and individualized surgical treatment of severe distal humeral bone defect.MethodsFive patients with severe distal humeral bone defects were treated with customized 3D printing prostheses between December 2010 and December 2015. There were 4 males and 1 female, with an age of 23-57 years (mean, 35 years); and the length of the bone defect was 5-12 cm (mean, 8 cm). The cause of injury was mechanical injury in 2 cases and strangulation in 3 cases. All of them were the open fracture of Gustilo type Ⅲ. There were 2 cases of radial fracture, 1 case of cubital nerve injury, and 3 cases of radial nerve injury. The time from injury to one-stage operation was 6-18 hours (mean, 10 hours). The operation time, intraoperative blood loss, and intraoperative fluoroscopy were recorded. During follow-up, the anteroposterior and lateral X-ray films of the elbow joints were performed to identify whether there was prosthesis loosening; Mayo Elbow Performance Score (MEPS) and upper extremity Enneking score were used to evaluate limb function.ResultsThe operation time was 140-190 minutes (mean, 165 minutes). The intraoperative blood loss was 310-490 mL (mean, 415 mL). The intraoperative fluoroscopy was 1-3 times (mean, 1.6 times). Five patients were followed up 14-38 months (mean, 21 months). The wound exudate occurred in 1 case and cured after anti-inflammatory local dressing change; the subcutaneous hematoma occurred in 1 case, and improved after color Doppler ultrasound guided puncture and drainage. The MEPS scores and the Enneking scores were all significantly improved when compared with preoperative ones (P<0.05). Except MEPS score between 6 and 12 months after operation had no significant difference (P>0.05), there were significant differences in MEPS scores and Enneking scores between the other time points (P<0.05). During the follow-up, no prosthetic loosening or joint dislocation occurred.Conclusion3D printing technology can achieve personalized treatment of severe distal humeral bone defects, obtain relatively good elbow joint function, and has less postoperative complications and satisfactory effectiveness.

Citation： ZHAO Xing, YU Li, TAO Shengxiang, DENG Linglong, WEI Chi, WANG Bing, ZHU Shaobo. Treatment of severe distal humeral bone defects with three-dimensional printing technology. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(12): 1534-1539. doi: 10.7507/1002-1892.201803008 Copy

1.	鐘世鎮, 方馳華. 三維打印技術的臨床應用. 中華外科雜志, 2016, 54(9): 658-660.
2.	Krauel L, Fenollosa F, Riaza L, et al. Use of 3D prototypes for complex surgical oncologic cases. World J Surg, 2016, 40(4): 889-894.
3.	Shafiee A, Atala A. Printing technologies for medical applications. Trends Mol Med, 2016, 22(3): 254-265.
4.	麥奇光, 谷誠, 林學智, 等. 個性化金屬三維打印髖臼翼形接骨板結合腹直肌外側切口入路治療復雜髖臼骨折. 中華外科雜志, 2017, 55(3): 172-178.
5.	曲龍, 施京輝, 劉黎亮, 等. 骨搬移法治療骨感染、骨缺損及軟組織缺損. 中華外科雜志, 2004, 42(23): 1469.
6.	Brydone AS, Meek D, Maclaine S. Bone grafting, orthopaedic biomaterials, and the clinical need for bone engineering. Proc Inst Mech Eng H, 2010, 224(12): 1329-1343.
7.	Chiarello E, Cadossi M, Tedesco G, et al. Autograft, allograft and bone substitutes in reconstructive orthopedic surgery. Aging Clin Exp Res, 2013, 25(Suppl 1): S101-S103.
8.	Friedrich MJ, Schmolders J, Lob G, et al. Intercalary reconstruction for diaphyseal bone defects with a modular replacement system: Clinical results. Oper Orthop Traumatol, 2015, 27(5): 455-462.
9.	Boos AM, Arkudas A, Kneser U, et al. Bone tissue engineering for bone defect therapy. Handchir Mikrochir Plast Chir, 2010, 42(6): 360-368.
10.	Giannoudis PV, Faour O, Goff T, et al. Masquelet technique for the treatment of bone defects: tips-tricks and future directions. Injury, 2011, 42(6): 591-598.
11.	Lee JH, Chung DW, Han CS. Outcomes of anterolateral thigh-free flaps and conversion from external to internal fixation with bone grafting in gustilo type ⅢB open tibial fractures. Microsurgery, 2012, 32(6): 431-437.
12.	Aurégan JC, Bégué T. Induced membrane for treatment of critical sized bone defect: a review of experimental and clinical experiences. Int Orthop, 2014, 38(9): 1971-1978.
13.	中華醫學會醫學工程學分會數字骨科學組. 3D 打印骨科模型技術標準專家共識. 中華創傷骨科雜志, 2017, 19(1): 61-64.
14.	Eltorai AE, Nguyen E, Daniels AH. Three-dimensional printing in orthopedic surgery. Orthopedics, 2015, 38(11): 684-687.
15.	Celik D. Psychometric properties of the Mayo Elbow Performance Score. Rheumatol Int, 2015, 35(6): 1015-1020.
16.	Wada T, Kawai A, Ihara K, et al. Construct validity of the Enneking score for measuring function in patients with malignant or aggressive benign tumours of the upper limb. J Bone Joint Surg (Br), 2007, 89(5): 659-663.
17.	劉興炎, 葛寶豐, 甄平, 等. 肱骨遠端難治性骨不連的修復. 中國修復重建外科雜志, 2005, 19(1): 52-53.
18.	Chalidis B, Dimitriou C, Papadopoulos P, et al. Total elbow arthroplasty for the treatment of insufficient distal humeral fractures. A retrospective clinical study and review of the literature. Injury, 2009, 40(6): 582-590.
19.	郭衛, 唐順, 楊榮利, 等. 定制型人工肘關節重建肘部腫瘤切除后骨缺損. 中華外科雜志, 2008, 46(22): 1734-1737.
20.	何方舟, 張偉濱, 沈宇輝. 定制型限制性全肘關節假體置換 8 例報告. 上海交通大學學報 (醫學版), 2016, 36(8): 1205-1209.
21.	郭衛, 王毅飛, 張熠丹, 等. 3D 打印組配式骨盆假體重建骨盆腫瘤切除后骨缺損. 中華骨科雜志, 2016, 36(20): 1302-1311.
22.	裴延軍, 吳智鋼. 西京醫院骨科完成亞洲首例 3d 打印鈦合金骨盆假體植入術. 中華創傷骨科雜志, 2014, 16(5): 后插 7.
23.	裴延軍, 吳智鋼. 世界首例 3D 打印鈦合金鎖骨和肩胛骨植入手術在西京醫院成功實施. 中華創傷骨科雜志, 2014, 16(5): 后插 6.
24.	仰東萍, 姚永玲. 北京大學第三醫院完成中國首例 3D 打印脊椎手術. 中華醫學信息導報, 2016, (14): 6.
25.	葉堃, 王金武, 胡志剛, 等. 3D 打印鈦合金個性化骨盆假體生物力學的初步有限元分析. 中華創傷骨科雜志, 2015, 17(1): 18-22.

1. 鐘世鎮, 方馳華. 三維打印技術的臨床應用. 中華外科雜志, 2016, 54(9): 658-660.
2. Krauel L, Fenollosa F, Riaza L, et al. Use of 3D prototypes for complex surgical oncologic cases. World J Surg, 2016, 40(4): 889-894.
3. Shafiee A, Atala A. Printing technologies for medical applications. Trends Mol Med, 2016, 22(3): 254-265.
4. 麥奇光, 谷誠, 林學智, 等. 個性化金屬三維打印髖臼翼形接骨板結合腹直肌外側切口入路治療復雜髖臼骨折. 中華外科雜志, 2017, 55(3): 172-178.
5. 曲龍, 施京輝, 劉黎亮, 等. 骨搬移法治療骨感染、骨缺損及軟組織缺損. 中華外科雜志, 2004, 42(23): 1469.
6. Brydone AS, Meek D, Maclaine S. Bone grafting, orthopaedic biomaterials, and the clinical need for bone engineering. Proc Inst Mech Eng H, 2010, 224(12): 1329-1343.
7. Chiarello E, Cadossi M, Tedesco G, et al. Autograft, allograft and bone substitutes in reconstructive orthopedic surgery. Aging Clin Exp Res, 2013, 25(Suppl 1): S101-S103.
8. Friedrich MJ, Schmolders J, Lob G, et al. Intercalary reconstruction for diaphyseal bone defects with a modular replacement system: Clinical results. Oper Orthop Traumatol, 2015, 27(5): 455-462.
9. Boos AM, Arkudas A, Kneser U, et al. Bone tissue engineering for bone defect therapy. Handchir Mikrochir Plast Chir, 2010, 42(6): 360-368.
10. Giannoudis PV, Faour O, Goff T, et al. Masquelet technique for the treatment of bone defects: tips-tricks and future directions. Injury, 2011, 42(6): 591-598.
11. Lee JH, Chung DW, Han CS. Outcomes of anterolateral thigh-free flaps and conversion from external to internal fixation with bone grafting in gustilo type ⅢB open tibial fractures. Microsurgery, 2012, 32(6): 431-437.
12. Aurégan JC, Bégué T. Induced membrane for treatment of critical sized bone defect: a review of experimental and clinical experiences. Int Orthop, 2014, 38(9): 1971-1978.
13. 中華醫學會醫學工程學分會數字骨科學組. 3D 打印骨科模型技術標準專家共識. 中華創傷骨科雜志, 2017, 19(1): 61-64.
14. Eltorai AE, Nguyen E, Daniels AH. Three-dimensional printing in orthopedic surgery. Orthopedics, 2015, 38(11): 684-687.
15. Celik D. Psychometric properties of the Mayo Elbow Performance Score. Rheumatol Int, 2015, 35(6): 1015-1020.
16. Wada T, Kawai A, Ihara K, et al. Construct validity of the Enneking score for measuring function in patients with malignant or aggressive benign tumours of the upper limb. J Bone Joint Surg (Br), 2007, 89(5): 659-663.
17. 劉興炎, 葛寶豐, 甄平, 等. 肱骨遠端難治性骨不連的修復. 中國修復重建外科雜志, 2005, 19(1): 52-53.
18. Chalidis B, Dimitriou C, Papadopoulos P, et al. Total elbow arthroplasty for the treatment of insufficient distal humeral fractures. A retrospective clinical study and review of the literature. Injury, 2009, 40(6): 582-590.
19. 郭衛, 唐順, 楊榮利, 等. 定制型人工肘關節重建肘部腫瘤切除后骨缺損. 中華外科雜志, 2008, 46(22): 1734-1737.
20. 何方舟, 張偉濱, 沈宇輝. 定制型限制性全肘關節假體置換 8 例報告. 上海交通大學學報 (醫學版), 2016, 36(8): 1205-1209.
21. 郭衛, 王毅飛, 張熠丹, 等. 3D 打印組配式骨盆假體重建骨盆腫瘤切除后骨缺損. 中華骨科雜志, 2016, 36(20): 1302-1311.
22. 裴延軍, 吳智鋼. 西京醫院骨科完成亞洲首例 3d 打印鈦合金骨盆假體植入術. 中華創傷骨科雜志, 2014, 16(5): 后插 7.
23. 裴延軍, 吳智鋼. 世界首例 3D 打印鈦合金鎖骨和肩胛骨植入手術在西京醫院成功實施. 中華創傷骨科雜志, 2014, 16(5): 后插 6.
24. 仰東萍, 姚永玲. 北京大學第三醫院完成中國首例 3D 打印脊椎手術. 中華醫學信息導報, 2016, (14): 6.
25. 葉堃, 王金武, 胡志剛, 等. 3D 打印鈦合金個性化骨盆假體生物力學的初步有限元分析. 中華創傷骨科雜志, 2015, 17(1): 18-22.

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