3D printing pre-operation assisted with custom-made plate for
internal fixation of femoral shaft fractures after poliomyelitis

doi:10.3969/j.issn.2095-4344.2552

Abstract

Abstract:

BACKGROUND: Patients with poliomyelitis often have abnormalities in the femur and the conventional plant matching degree of fracture is low. There are few reports on individualized treatment for severe deformity of femoral shaft fracture in poliomyelitis.

OBJECTIVE: To summarize the clinical features of femoral shaft fracture in poliomyelitis and discuss the operative outcome of 3D printing pre-operation assisted with custom-made plate.

METHODS: From May 2015 to May 2018, data of 19 patients with poliomyelitis surgically treated with 3D printing pre-operation assisted with custom-made plate were retrospectively analyzed. There were 11 males and 8 females with an average age of 52.5 years (range, 38-62 years). There were 7 cases on the left side, and 12 cases on the right side. According to AO/OTA classification of femoral shaft fracture, there were type A1 in 6 cases, type A2 in 3 cases, type A3 in 1 case, type B1 in 4 cases, type B2 in 4 cases and type C1 in 1 case. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. The 3D printed 1:1 femur model and custom-made plate were designed. Operation was simulated in vitro in femoral model. The placement of the plate was identified. The direction and length of the screws were measured and recorded. The final internal fixation of fracture was performed according to the pre-operation results. Hip and knee functions in the affected limb were assessed based on Harris evaluation criterion and hospital for special surgery knee score evaluation criterion.

RESULTS AND CONCLUSION: (1) All 19 patients were followed up for 12-18 months. Bone healing was obtained in all fractures, with a healing time of 5-12 months, averaging 6.6 months. (2) Harris score was (84.95±5.18) before injury, and (84.42±4.83) 1 year after operation. Hospital for special surgery knee score was (84.53±4.36) before injury, and (83.63±3.90) 1 year after operation. Statistical analysis showed no statistical difference between the two groups before and after the injury (P > 0.05). (3) All patients had no internal fixation loosening or fracture. One patient had delayed bone healing and healed after iliac bone grafting. One patient developed wound infection after surgery, and received adequate drainage. Wound was healed after intravenous application of sensitive antibiotics. (4) Patients with poliomyelitis often have abnormalities in the femur with varying degrees of osteoporosis. For femoral shaft fractures that cannot be fixed with conventional internal fixation, 3D printing pre-operation combined with custom-made steel plate provides a new choice for the treatment of femoral shaft fractures in poliomyelitis.

Key words: poliomyelitis, femoral shaft fracture, 3D printing, simulated operation, custom-made plate, fracture healing

CLC Number:

Zhang Shijian, Yang Chaoqun, Qi Haotian, Liu Zhaojie, Wang Hongchuan, Tian Wei, Jia Jian. 3D printing pre-operation assisted with custom-made plate for internal fixation of femoral shaft fractures after poliomyelitis[J]. Chinese Journal of Tissue Engineering Research, 2020, 24(12): 1875-1880.

Figures/Tables 4

患者受伤前髋关节功能Harris评分丢分项目主要在轻微疼痛、步态(不同程度跛行及长距离行走需要拄拐辅助或不能长距离行走)、上楼梯需扶侧梯等方面，而在髋关节活动度、关节稳定性方面丢分较少；术后髋关节功能丢分项目较术前基本一致，部分患者行走距离较前减少，而上述丢分项目和膝关节功能差以及下肢肌力差、患者较健侧缩、患侧存在马蹄内翻足等有关。受伤前膝关节功能美国纽约特种外科医院膝关节评分丢分项目主要集中在行走时轻微疼痛、行走距离受限制、肌力不能完全抗阻，膝关节稳定性差等；术后患者关节功能丢分项目和术前基本一致，术后3例患者出现膝关节屈曲较伤前受限，分别为2例屈曲95°、1例100°，伸直活动度较伤前无明显变化，但患者基本日常活动基本恢复到伤前状态，说明定制钢板内固定治疗小儿麻痹股骨骨折并没有加重患者残疾程度。 2.7 并发症情况所有患者无钢板、螺钉断裂、内固定失效等严重并发症。术后1例患者出现骨折延迟愈合，术后8个月X射线片见骨痂少，骨折线仍可见，断端可见约2 mm分离，且已连续观察3个月未见明显骨痂增多，患肢仍未完全负重行走，患肢活动后仍有疼痛。经再次收入院二次手术，术中见断端稳定，保留原定制钢板，于骨折断端四周大量植骨，植骨区域达骨折端上下各5 cm。术后4个月复查X射线片见连续性骨痂生长，骨折线已模糊，且患者日常活动断端无明显疼痛。术后1例患者出现切口感染，该患者于术后第6天出现发热，体温最高达39.4 ℃，切口局部红肿、皮温增高，渗出黄色分泌物，连续拆除3针缝线，见黄色浓稠分泌物流出，细菌培养示金黄色葡萄球菌，伤口放置纱条引流、每日换药用复合溶葡萄球菌消毒剂冲洗，依据药敏实验结果静脉应用敏感抗生素，感染局限后经彻底清创，患者伤口愈合。 2.8 植入物与宿主的生物相容性 19例患者应用的定制钢板生物相容性好，均未出现内植物周围感染、过敏反应、免疫反应及排斥反应等。 "

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