摘要
目的探讨采用3D打印技术辅助设计游离腓骨头复合组织瓣移植精准修复内踝缺损的临床应用及疗效。方法自2015年3月至2021年11月,西安市红会医院手外科共收治4例外伤导致踝部内侧损伤一期修复创面后内踝骨缺损的患者,均于外院行一期治疗,其中3例伴内侧韧带缺损,清创后采用游离皮瓣修复,皮瓣面积4.0 cm×7.0 cm~10.0 cm×15.0 cm;1例不伴韧带缺损者采用植皮覆盖创面,植皮面积3.0 cm×5.0 cm。3个月后行3D打印辅助设计游离腓骨头复合组织瓣修复内踝缺损,术前进行双侧踝关节CT平扫及三维成像获取数据,进行双侧踝关节3D打印,打印出双侧踝关节模型,采用镜像对比打印出患侧缺损内踝的模型,体积1.5 cm×2.0 cm×3.0 cm~1.5 cm×2.0 cm×5.0 cm。于健侧膝关节外侧切取携带股二头肌腱的复合组织瓣移植修复内踝骨缺损,重建内侧三角韧带(3例)及内侧三角韧带止点(1例)。复合组织瓣携带膝下外侧动脉及静脉与受区血管吻合,重建移植复合组织瓣的血供。术后抗凝、抗感染、抗痉挛治疗,患肢制动1个月。术后前3个月每月复查X线片,3个月后每2个月复查X线片,并定期来院复诊,依据美国足踝外科协会(AOFAS)踝及后足功能评分标准进行踝关节功能评定,按照Rasmussen评分系统进行膝关节功能评定。结果所有移植组织块均成活,创口均一期愈合,随访19~35(平均29)个月,术后2~3个月重建内踝骨块于受区获得骨痂,4~6个月获得骨性愈合;依据AOFAS踝及后足功能评分标准,评分为89~100分,均为优;膝关节功能按Rasmussen评分系统评分为28~30分,均为优。结论采用3D打印技术辅助设计结合显微技术游离腓骨头复合组织瓣移植修复内踝缺损,可一次性修复骨缺损及韧带缺损,可以做到精准修复,受区愈合快,供区损伤小,为临床一种较好选择。
Objective To investigate the clinical application and effect of transfer of free composite tissue flap with fibula head designed with 3D printing for accurate reconstruction of medial malleolar defect.Methods From March 2015 to November 2021,there were 4 patients with bone defect of medial ankle after initial repair due to medial ankle injury caused by trauma.All 4 patients were primarily treated in other hospitals.To whom,3 patients with bone and medial ligament defects were reconstructed by free flap after debridement.Size of flaps was 4.0 cm×7.0 cm-10.0 cm×15.0 cm.The patient who had no ligament defect was covered by skin grafting,and the size of skin graft was 3.0 cm×5.0 cm.After 3 months,the defect of medial malleolus was reconstructed by free composite tissue flap with fibula head assisted by 3D printing in Department of Hand Surgery,Honghui Hospital of Xi'an.Bilateral ankle CT scans and 3D image reconstructions were performed before surgery to acquire the data of both ankles,then 3D printing was performed to produce the templates of both ankles,and the profile of the medial malleolus defects on the affected side was printed for mirror comparison.The volumes of bone defect at medial ankle were measured from 1.5 cm×2.0 cm×3.0 cm to 1.5 cm×2.0 cm×5.0 cm.Compound tissue flaps carrying biceps tendon were taken from the healthy lateral knees and transferred to medial ankle for reconstruction of the bone,medial triangular ligament(3 cases)and insertion of the medial deltoid ligament(1 case).The inferior lateral genicular arteries and veins carried by the composite tissue flaps were anastomosed with the arteries and veins at the recipient site to establish blood supply of the flap.Anticoagulation,anti-infection,anti-spasticity treatment were routinely offered,and the affected limb was immobilised for 1 month after surgery.Monthly X-ray reviews were carried out for 3 months after surgery,then followed by 2 monthly X-ray reviews.Ankle function was assessed according to the ankle and hindfoot function score of American Orthopedic Foot and Ankle Society(AOFAS).Knee function was assessed with Rasmussen score system.Results All tissues of the composite tissue flaps survived and the wounds healed primarily.Postoperative follow-up lasted 19-35(mean 29)months.Calluses were formed at the reception site at 2 to 3 months and bone healings achieved at 4 to 6 months after surgery.According to the AOFAS,the scores of ankle and hind foot function were 89-100 points.Knee function was scored 28-30 points according to Rasmussen scoring system,and all 4 patients were rated excellent.Conclusion It could be a better choice to apply the 3D printing assisted microsurgical techniques in transfer of free composite tissue flap with fibula head in reconstruction of medial malleolar injury with bone and ligament defects.It can achieve an accurate reconstruction and a quick healing with a minimal damage to the donor site.
作者
欧学海
李刚
段宏昊
杜晓龙
张丽君
OU Xuehai;LI Gang;DUAN Honghao;DU Xiaolong;ZHANG Lijun(Department of Hand Surgery,Honghui Hospital,Xi’an 710054,China)
出处
《中华显微外科杂志》
CSCD
北大核心
2024年第2期148-153,共6页
Chinese Journal of Microsurgery
基金
陕西省社会发展一般项目(2021SF-241)。
关键词
内踝缺损
3D打印
复合组织瓣
修复
数字医学
显微外科技术
Medial malleolar defects
3D printing
Compound tissue flap
Reconstruction
Digital medicine
Microsurgical technique
