摘要
目的探讨3D打印技术在辅助手部桡侧严重毁损伤修复中的应用价值。方法2014年3月至2016年9月，对手部桡侧不同程度掌、指骨伴皮肤软组织严重毁损伤的9例，术前使用64排螺旋CT分别对供区、受区进行扫描，通过CTA三维重建技术获得三维图像。应用Mimics软件虚拟手术辅助设计系统的镜像技术和虚拟手术辅助设计技术进行设计.实施带足背皮瓣的蹰甲瓣联合第2趾骨移植再造拇指及股前外侧穿支皮瓣修复创面9例。足背皮瓣与股前外侧穿支皮瓣的切取面积分别为4.0cm×5.5cm～6.5cm×9.5cm、9.5cm×17.0cm～12.0cm×25.5cm。术后定期随访.评估手术疗效。结果术后再造拇指9例及皮瓣全部成活，随访8～16个月.再造拇指外观接近正常，两点辨别觉8.0~11.0mm.按中华医学会手外科学会上肢部分功能评定试用标准评定：优7例，良2例。成活皮瓣质地柔软、血运良好，修复部位外形不臃肿。结论3D打印技术辅助手桡侧严重毁损伤进行拇指再造及创面修复，临床效果良好。
Objective To evaluate the value of 3D printing technology to assist in the repair of severe damage to the radial side hand. Methods From March, 2014 to September, 2016, there were 9 cases suffered from varying degrees of metacarpal and phalangeal bones injuries with soft tissue destruction at the radial side of the hand. The donor and recipient areas were scanned by 64 row spiral CT before operation. Three dimensional images were obtained by CTA 3D reconstruction technology. Preoperative plan was designed by using Mirror image technology and Virtual surgery aided design technique of Mimics software virtual surgery aided design system. Nine cases were treated with first toe toenail flap with dorsal foot flap combined with second phalangeai bone transplantation to reconstruct thumb and anterolateral thigh perforator flap to repair the wound. The cutting area of the dorsalis pedis flap and anterolateral thigh perforator flaps ranged from 4.0 cm×5.5 cm to 6.5 cm × 9.5 cm and from 9.5 cm × 17.0 cm to 12.0 cm × 25.5 cm, respectively. Postoperative followed-up was performed to evaluate the effect of the operation. Results All 9 thumbs and flaps survived after the operation. Postoperative followed-up time ranged from 8 to 16 months. The appearance of reconstructed thumb was close to normal, and the two-point discrimination was from 8.0 to 11.0 mm. According to the evaluation criteria of upper limb function of the Chinese Academy of Medical Sciences, 7 cases were excellent and 2 cases were good. The survival flaps had soft texture, good blood circulation and satisfactory appearance at the repaired site. Conclusion 3D printing technology assists thumb reconstruction and wound repair for severe damage to the radial side of the hand with good clinical results.
作者
莫勇军
程志琳
许林
谭海涛
韦平欧
罗翔
黄国秀
林汉
梁旭权
Mo Yongjun;Cheng Zhilin;Xu Lin;Tan Haitao;Wei Ping＇ou;Luo Xiang;Huang Guoxiu;Lin Han;Liang Xuquan(Department of Orthopaedics of Guigang City People＇s Hospital,Guigang,Guanxi Zhuang Autonomous Region 537100,China)
出处
《中华显微外科杂志》
CSCD
北大核心
2018年第4期334-338,共5页
Chinese Journal of Microsurgery
基金
广西数字医学与3D打印临床医学研究中心建设项目（桂科AD17129017）
关键词
手桡侧毁损伤
拇指再造
3D打印技术
股前外侧皮瓣
显微外科手术
Destruction of the radial side of the hand
Thumb reconstruction
3D printing technology
Anterolateral thigh flap
Mierosurgical operation
