3D打印联合肱骨远端截骨治疗儿童肘内翻畸形

目的:探讨采用3D打印技术联合肱骨远端截骨治疗儿童肘内翻畸形的临床疗效。方法:回顾性分析自2017年1月至2020年1月行肱骨远端截骨矫形手术治疗的肘内翻畸形患儿17例,其中男11例,女6例;年龄5~11(7.8±1.7)岁。术前通过3D打印技术制作患侧肘关节模型,在模型上进行预手术,术中利用3D模型指导进行肱骨远端截骨矫形术。比较术前、术后6个月肘关节提携角、肘关节屈曲伸直角度变化情况,采用Flynn分级评价标准评价其临床疗效。结果:17例患儿均获得随访,时间6~12(9.6±1.7)个月。1例患儿出现伤口感染,予换药后完全愈合。所有患儿无骨不愈合、内固定断裂及神经损伤等并发症发生。患肢提携角由术前的(-20.8±2.4)°改善至术后6个月的(7.2±2.3)°;肘关节伸直角度由术前的(-5.6±3.9)°改善至术后6个月的(-2.6±2.1)°,术后6个月肘关节屈曲角度与术前比较差异无统计学意义(P>0.05);术后6个月患侧肘关节功能与健侧比较差异无统计学意义(P>0.05)。根据Flynn分级评价标准,优13例,良4例。结论:采用3D打印联合肱骨远端截骨治疗儿童肘内翻畸形,能够获得满意的治疗效果,利用该技术可以更精确地完成畸形矫正,恢复肘关节生理结构及功能。

Department of Orthopaedics,Ningbo No.6 Hospital,Ningbo 315000,Zhejiang,China

Objective: To explore clinical effect of three-dimensional(3D) printing combined with distal humerus osteotomy for children with cubital varus deformity.Methods: From January 2017 to January 2020,17 cubital varus deformity children treated with distal humerus osteotomy were retrospective analysis,included 11 boys and 6 girls,aged from 5 to 11 years old with an average of (7.8±1.7) years old. A model of affected side elbow joint was made by 3D printing technique before operation,pre-operation was performed on the model. Three-dimensional model was successfully used for distal humeral osteotomy during operation. Carrying angle,flexion and extension angle of elbow joint were compared before and six months after operation,and Flynn scoring criteria was used to evaluate clinical effect.Results: All children were followed up for 6 to 12 months with an avergae of (9.6±1.7) months. One child occurred wound infection and healed completely after dressing change. No complications such as nonunion,internal fixation and nerve injury occurred. Carrying angle of affected limb was improved from (-20.8±2.4)°before operation to (7.2±2.3)åt 6 months after operation (P<0.01). Angle of affected elbow joint extension improved from (-5.6±3.9)° before opeation to(-2.6±2.1)åt 6 months after operation (P<0.01). There was no significant difference in extension angle of elbow joint between preopertaion and postopertaion at 6 months (P>0.05). While there was no difference in elbow joint function on the healthy side and affected side at 6 months after opertaion (P>0.05). According to Flynn scoring criteria,13 patients got excllent results and 4 moderate.Conclusion: Three-dimensional printing combined with distal humerus osteotomy in treating elbow varus deformity could receive satisfactory clinical effect,which could accurately assist correction of cubital varus deformity,restore physiological structure and function of elbow joint.