The patient, an 81-year-old woman, was hospitalized in the Department of Geriatric Trauma and Orthopedics of Jishuitan Hospital because of a fall on her right hip. In particular, the patient was diagnosed with a right femoral neck fracture 7 years ago due to his right hip landing after a fall. This fracture is also known as the "last fracture of life" in the elderly, and the mortality and disability after the fracture are high. The rate is very high. The old man underwent artificial femoral head replacement at that time, and he quickly recovered to a normal life after the operation. He walked freely for 7 years. Unfortunately, the patient suffered a second fall injury that resulted in a periprosthetic fracture of the right femur, which was more complicated, more difficult to treat, and more operative than the previous one.
By sorting out the elderly patients with hip fractures diagnosed and treated by the Department of Trauma and Orthopedics of Beijing Jishuitan Hospital in the past, the team of Vice President Wu Xinbao and Chief Physician Yang Minghui found that with the increase of elderly patients with hip fractures, the number of artificial hip replacements has also gradually increased. Such patients are also at high risk of further fall injury, which means that periprosthetic femoral fractures will also increase in older adults. The treatment of such elderly femoral periprosthetic fractures has always been a difficult problem for orthopaedic physicians. In the treatment, three aspects of fracture, prosthesis and bone mass must be taken into account. No matter what treatment plan is adopted, the treatment is very difficult.
For this elderly man with secondary fragility orthopedics, the treatment team considered that most of the current periprosthetic fracture plates do not match the shape of the patient's proximal femur and cannot be well attached to the surface of the proximal femur, which is likely to cause metal objects to irritate the surrounding soft tissue. It will affect the recovery of limb function after surgery. In addition, the presence of the prosthesis prevents the placement of screws at the proximal end of the plate, and there is no dedicated channel for cable cerclage on the plate, resulting in unstable fracture fixation and failure of the internal fixator in the long-term. It would be a disastrous outcome for the elderly with subfragile fractures.
Therefore, through a comprehensive analysis of the patient's condition, the treatment team decided to adopt the 3D printing technology that is currently at the forefront of orthopedic treatment. The traditional 3D printing custom steel plate is just a 3D printing of the femur model, and then the customized steel plate is processed by the machine tool. Through the medical-engineering interaction system of AK Medical, the R&D engineer team closely cooperates with the team of Professor Wu Xinbao. According to the image data of the patient's affected limb, a specially designed The anatomical femoral periprosthetic plate is made by custom-made metal 3D printing technology. The customized plate uses an innovative design. Morphologically, the hook-like structure at the proximal end of the plate can fit perfectly with the patient's major trochanter. The plate has specially made a channel for the cerclage cable in the femoral prosthesis segment, which makes the operation easier. It is simple and convenient, and the plate is designed with 4 screw holes in the distal part of the prosthesis for the placement of bicortical screws. The stable fracture fixation ability of the whole customized plate system, the anatomical shape design for easy reduction and fixation, and the precise functions of the trochanteric hook and the proximal cerclage channel form a fracture internal fixation system that integrates three major advantages. , so as to avoid the deficiencies of traditional internal fixators, and at the same time take into account the needs of periprosthetic fractures, prosthesis and insufficient bone mass, increase the strength of internal fixation for fractures, and more reliably ensure the clinical treatment goal of fracture healing.
After detailed preoperative planning by the treatment team, on January 12, 2022, the team successfully completed the reduction and fixation of the fracture according to the surgical design. The operation took 1 hour and 45 minutes and the blood loss was 400ml. Postoperative images showed that the fracture was anatomically reduced, the custom-made plate was positioned properly, and the cable cerclage and screw placement were ideal, which perfectly achieved the surgical goals of preoperative planning.
For elderly patients with osteoporosis and special fracture site morphology, especially for patients with fractures that occur around artificial joint prostheses, good reduction and firm fixation of the fracture are the prerequisites for fracture healing and restoration of the function of the affected limb. For patients with abnormal anatomy of the fracture site, conventional steel plates cannot achieve perfect anatomical attachment to the fracture site structure. The use of customized prostheses can achieve convenient fracture reduction, reduce postoperative foreign body sensation, and improve fracture fixation. reliable.
At present, "3D printing customized surgical technology" has become one of the effective treatment methods for specific groups of people, which can greatly reduce the complications caused by insufficient traditional treatment methods, and can provide patients with more effective clinical treatment effects. However, this technology also has shortcomings such as a slightly longer waiting time for printing and a lack of special surgical tools, which needs to be further improved in clinical practice.
