3D打印患手模型指导个性化选择皮瓣治疗虎口挛缩的效果研究

doi:10.13418/j.issn.1001-165x.2022.2.19

摘要/Abstract

摘要： 目的　探讨利用3D打印患手模型指导个性化选择皮瓣治疗虎口挛缩的临床效果。方法　自2018年3月至2019年10月，对10例虎口中~重度挛缩者，术前3D打印患手模型，依据模型设计虎口开大后创面的形状及面积，个性化选择合适的皮瓣修复创面，术中比对验证，术后随访观察治疗效果。结果　术中发现创面形状及面积与术前模拟设计基本一致，皮瓣选择与术前模拟一致，10例皮瓣均成活，供区及受区创面Ⅰ期愈合，随访6 ~ 12个月，皮瓣外形满意，感觉部分恢复，拇指恢复外展及对掌功能，虎口角度增加50~60 °（平均53.4 °），虎口宽度增加18 ~ 35 mm（平均31.3 mm），虎口修复评定：优7例，良2例，中1例。结论　术前3D打印患手模型可指导个性化的皮瓣，使虎口挛缩开大的创面达到精准修复，减少手术时间，术后虎口外形及功能恢复良好。

关键词: 3D打印, 　虎口挛缩, 　皮瓣, 　个性化

Abstract: Objective　To investigate the clinical application of individualized skin flap in the treatment of contracture of first web space by 3D printing the model of the affected hand.　Methods　From March 2018 to October 2019, 10 cases of moderate and severe contracture of first web space were treated with 3D printing of the affected hand model before operation. The appropriate flaps were selected to repair the wound individualized according to the shape and area of the wound after opening the first web space of the model. Intraoperative comparison and verification, postoperative follow-up were performed to observe the treatment effect.　Results　The shape and area of the wound and the flap selection were basically in accordance with that of the preoperative simulation design. All the 10 cases of flaps survived, and the donor and recipient wound were healed at I stage. All flaps were followed up for 6~12 months. The appearance of the flaps was satisfactory, the sensation was partial recovered the abduction and opposition function of the thumb were restored. The angle of first web space increased by 50°-60°(with an average of 53.4°), and the width increased by 18mm-35 mm (with an average of 31.3 mm). The repair evaluation of the first web space were excellent in 7 cases, good in 2 cases, medium in1 case.　Conclusions　The 3D printing of the affected hand model before operation can guide the individualized skin flap, so that the enlarged wound with contracture can be repaired accurately, the operation time can be reduced, and the shape and function of the first web space can be recovered well after operation.

Key words: 3D printing, 　Contracture of the first web space, 　Flap, 　 Individualized

中图分类号:

郭礼平, 巨积辉, 周荣, 王健, 余新水. 3D打印患手模型指导个性化选择皮瓣治疗虎口挛缩的效果研究[J]. 中国临床解剖学杂志, 2022, 40(2): 221-224.

Guo Liping, Ju Jihui, Zhou Rong, Wang Jian, Yu Xinshui. 3D printing the affected hand model to guide the individualized selection of flap in the treatment of contracture of the first web space[J]. Chinese Journal of Clinical Anatomy, 2022, 40(2): 221-224.

参考文献 22

[1]	路来金, 宫旭, 余新, 等. 虎口挛缩的皮瓣修复[J]. 中华显微外科杂志, 2010, 33(2): 110-111. DOI: 10.3760/cma.j.issn.1001-2036.2010.02.009.
[2]	郑大伟, 黎章灿, 石荣剑, 等. 腕横纹逆行岛状皮瓣修复虎口瘢痕挛缩16例[J]. 中华显微外科杂志, 2019, 42(2): 170-172. DOI: 10.3760/cma.j.issn.1001-2036.2019.02.017.
[3]	俞淼, 史增元, 尹维刚, 等. 虎口区背侧逆行岛状皮瓣的应用解剖[J]. 中国临床解剖学杂志, 2009, 27(5): 520-522. DOI: CNKI: SUN:ZLJZ.0.2009-05-007.
[4]	姚建民, 徐靖宏, 谢庆平, 等. 四肢精准显微外科: 认知艺术化和技术人文化[J]. 中华显微外科杂志, 2015, 38(4): 313-315. DOI: 10.3760/cma.j.issn.1001-2036.2015.04.001.
[5]	Jensen CB, Rayan GM, Davidson R. First web space contracture and hand function[J]. J Hand Surg Am, 1993, 18(3): 516-520. DOI: 10.1016/0363-5023(93)90103-A.
[6]	顾玉东, 吴敏明, 郑忆柳, 等. 虎口挛缩的病因、预防及治疗[J]. 中华骨科杂志,1986,6(1):1-3.DOI:10.3760/cma.j.issn.0253-2352.1986.01.101.
[7]	刘小俊, 王志学, 苏建东, 等. 股前外侧薄皮瓣在修复重建外科的应用进展[J]. 中国临床解剖学杂志, 2019, 37(1): 110-112. DOI: 10.13418/j.issn.1001-165x.2019.01.023.
[8]	张楠, 史增元, 尹维刚, 等. 第1掌背动脉逆行岛状皮瓣的应用解剖学[J]. 中国临床解剖学杂志, 2012, 30(3): 264-267.
[9]	侯书健, 程国良, 方光荣, 等. 外伤性拇指指蹼挛缩的I临床分型与治疗[J]. 中华手外科杂志, 2001, 17(z1): 4-6. DOI: 10.3760/cma.j.issn.1005-054X.2001.z1.002.
[10]	王光华, 卫伟. 手瘢痕挛缩畸形整形疗效分析[J]. 中国美容医学, 2017, 26(2): 26-28. DOI: 1008-6455(2017)02-0026-02.
[11]	汤样华, 曾林如, 胡中青, 等. 穿支皮瓣移植修复虎口皮肤软组织缺损35例[J]. 中华创伤杂志, 2017, 33(9): 834-837. DOI: 10.3760/cma.j.issn.1001-8050.2017.09.011.
[12]	陈彦名, 唐举玉, 谢松林, 等. 腓肠内侧动脉穿支皮瓣游离移植修复重度虎口瘢痕挛缩[J]. 中华手外科杂志, 2017, 33(3): 190-192. DOI: 10.3760/cma.j.issn.1005-054X.2017.03.013.
[13]	魏诚, 巨积辉, 金乾衡, 等. 第一掌背动脉岛状皮瓣修复虎口瘢痕挛缩[J]. 中华手外科杂志, 2018, 34(2): 141-142. DOI: 10.3760/cma.j.issn.1005-054X.2018.02.023.
[14]	熊胜, 巨积辉, 金光哲, 等. 彩超定位下游离腓浅动脉穿支皮瓣修复手足部创面[J]. 中华手外科杂志, 2018, 34(6): 418-420. DOI: 10.3760/cma.j.issn.1005-054X.2018.06.007.
[15]	黄显华, 夏远军, 章莹, 等. 股前外侧皮瓣修复拇指虎口及邻近组织毁损伤[J]. 中国骨科临床与基础研究杂志, 2019, 11(2): 104-108. DOI: 10.3969/j.issn.1674-666X.2019.02.007.
[16]	熊胜, 巨积辉, 金光哲, 等. 游离同侧多块小腿腓浅动脉穿支皮瓣修复手部多发创面效果观察[J]. 中华烧伤杂志, 2019, 35(9): 655-660. DOI: 10.3760/cma.j.issn.1009-2587.2019.09.003.
[17]	邓伟, 巨积辉, 李雷, 等. 血流桥接型股前外侧皮瓣修复下肢主干血管及软组织缺损创面[J]. 中国临床解剖学杂志, 2017, 35(6): 676-680. DOI: 10.13418/j.issn.1001-165x.2017.06.017.
[18]	Qiu B, Liu F, Tang B, et al. Clinical study of 3D imaging and 3D printing technique for patient- specific instrumentation in total knee a-rthroplasty[J]. J Knee Surg, 2017, 30(8): 822-828. DOI: 10.1055/s-0036-1597980.
[19]	刘刚. 3D打印技术在复杂创伤骨科教学中的应用[J]. 课程教育研究, 2018, (47): 229. DOI: 2095-3089(2018)47-0223-01.
[20]	刘军, 黎逢峰, 吴永伟, 等. 膝降动脉作为游离股前外侧皮瓣受区血管的临床应用[J]. 中国临床解剖学杂志, 2018, 36(4): 426-429. DOI: CNKI:SUN:ZLJZ.0.2018-04-016.
[21]	李文鹿, 乔永明, 李锐, 等. 数字化与3D打印技术辅助腓骨皮瓣修复重建上颌骨缺损八例[J]. 中华显微外科杂志, 2018, 41(3): 273-275. DOI: 10.3760/cma.j.issn.1001-2036.2018.03.020.
[22]	Gellman H, Botte MJ, Shankwiler J, et a1. Arterial patterns of the deep and superficial palmar arches[J]. Clin Orthop Relat Res, 2001, 383: 41-46. DOI: 10.1097/00003086-200102000-00007.