3D打印支具治疗腱性锤状指的体会
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摘要
目的观察应用3D打印技术个体化定制支具非手术治疗腱性锤状指疗效。方法 2015年6月—2016年12月哈尔滨市第五医院收治44例闭合腱性锤状指患者。根据治疗方法将患者分为3D组和普通支具组,各22例22指。3D组应用自行研制锤状指复位体位支具,3D扫描后打印。普通支具组应用传统支具非手术治疗腱性锤状指患者。并依据手功能Patel评定法对患指功能进行评价。结果所有患者均8周拆除外固定,经功能练习,远指间关节(distal interphjalangeal joint,DIP)背伸功能均恢复良好,近指间关节(proximal interphjalangeal joint,PIP)无挛缩屈伸活动度良好。随访3～12个月,平均6.6个月,无失访,依据手功能Patel评定法,3D组优15例,良7例;普通支具组优6例,良16例。3D组支具所有患者未发生支具折断、碎裂、损坏情况,无固定失效情况发生,无一例产生压疮,2例患者因肿胀消褪二次更换支具。而普通支具组2例患者产生压疮,5例患者因支具固定失效二次更换支具。结论 3D支具固定可靠,不易形成压疮,便于观察甲板血运,指体肿胀消褪后可再次依据伤指外形快速打印更换支具,并且费用低廉,是一种治疗腱性锤状指理想有效的治疗方式。
Objective To observe the effect of 3D printing technique in treating tendinous mallet finger. Methods From Jun. 2015 to Dec. 2016, 44 closed tendionous mallet finger patients were admitted to the Fifth Hospital of Harbin. Patients were randomly divided into 3D printing brace group and traditional brace group according to different treating methods, with 22 patients in each group. Patients were evaluated according to the hand function Patel scoring standard. Results All patients were removed brace after 8 weeks. After function rehabilitation, distal interphjalangeal joint obtained good extension function, and proximal interphalangeal joint had no contracture and had good mobility. All patients were followed up for 3 to 12 months with an average of 6.6 months. According to the Patel scoring standard, the 3D printing brace group showed excellent in 15 cases, good in 7 cases, while the traditional brace group showed excellent in 6 cases, and good in 16 cases. No patient in the 3D printing brace group had brace breakage, fragmentation, damage, or fixation failure, and 2 patients had replaced brace due to swelling subsides. In the traditional brace group, 2 patients developed pressure sores, and 5 patients had the brace changed due to fixation failure. Conclusion The 3D printing brace has advantages of firm fixation, less pressure sores, easy to observe the blood supply of the nail bed, and low cost. Hence, it is an ideal and effective treatment way for tendinous mallet finger.
Objective To observe the effect of 3D printing technique in treating tendinous mallet finger. Methods From Jun. 2015 to Dec. 2016, 44 closed tendionous mallet finger patients were admitted to the Fifth Hospital of Harbin. Patients were randomly divided into 3D printing brace group and traditional brace group according to different treating methods, with 22 patients in each group. Patients were evaluated according to the hand function Patel scoring standard. Results All patients were removed brace after 8 weeks. After function rehabilitation, distal interphjalangeal joint obtained good extension function, and proximal interphalangeal joint had no contracture and had good mobility. All patients were followed up for 3 to 12 months with an average of 6.6 months. According to the Patel scoring standard, the 3D printing brace group showed excellent in 15 cases, good in 7 cases, while the traditional brace group showed excellent in 6 cases, and good in 16 cases. No patient in the 3D printing brace group had brace breakage, fragmentation, damage, or fixation failure, and 2 patients had replaced brace due to swelling subsides. In the traditional brace group, 2 patients developed pressure sores, and 5 patients had the brace changed due to fixation failure. Conclusion The 3D printing brace has advantages of firm fixation, less pressure sores, easy to observe the blood supply of the nail bed, and low cost. Hence, it is an ideal and effective treatment way for tendinous mallet finger.
引文
[1] 刘军,陈峰,艾名洋,等.移植肌腱隧道法重建伸肌腱止点治疗特殊类型锤状指21例分析[J].创伤外科杂志,2017,19(9):704-705.
[2] 张延茂,李国华,刘会仁,等.小切口改良Ishiguro法治疗骨性锤状指[J].创伤外科杂志,2010,12(2):173.
[3] Turtle HG,Stma PJ.Tendon avulsion injuries of the distal phalanx[J].Clin Orthop Relat Res,2006,445(3):157-168.
[4] 潘勇卫,田光磊,李淳,等.改良支具固定治疗陈旧腱性锤状指[J].中华手外科杂志,2010,26(6):328-330.
[5] 陈少贞,张涛,朱庆棠,等.两种不同外固定方式对新鲜锤状指临床疗效的单盲随机对照研究[J].中国康复医学杂志,2012,27(11):1006-1010.
[6] Brzezienski MA.Schneider LH.Extensor tendon injuries at the distal interphalangeal joint[J].Hand Clin,1995,11(3):373.
[7] Garberman SF,Diao E,Peimer CA.Mallet finger:results of early versus delayed closed treatment[J].J Hand Surg (Am),1994,19(5):850.
[8] Geyman TP,Fink K,Sullivan SD.Conservative versus surgical treatment of mallet finger: a pooled quantitative literature evaluation[J].J Am Board Fam Pract,1998,11(5):382.
[9] 王树寰.手部创伤的修复[M].北京:北京出版社,1997:204-208.
[10] 顾玉东,王澍寰,侍德.手外科学[M].上海:上海科学技术出版社,2002:492-496.
[11] 刘非,邱冰,薛向东,等.基于3D打印技术的个性化外固定支具设计[J].中国矫形外科杂志,2016,24(24):2260-2263.
[12] 刘广涛,马会力,齐岩,等.3D生物打印技术在骨创伤中的应用进展[J].医学综述,2017,23(7):1291-1295.
[13] 刘建坤,邓术才.3D打印技术在脊柱外科中的地位与作用[J].中国组织工程研究,2017,21(7):1131-1136.
[14] 施劲,王骏.锤状指保守治疗效果及影像因素分析[J].中国康复医学杂志,2017,32(7):826-828.
[15] 陈履平,张诗兴,孙贤敏,等.陈旧性锤状指的显微解剖与治疗研究[J].中华手外科杂志,1994,10(1):34-36.
[16] Patel MR,Desai SS,Bassini-Lipson L.Conservative management of chronic mallet finger[J].J Hand Surg(Am),1986,11(4): 570-573.
[17] 刘志刚,路来金,于家傲.伸肌腱器终腱的形态特点及其临床应用[J].中国临床解剖学杂志,2002,20(2):253-255.
[18] 刘璠,侍德.槌状指的手术治疗[J].中华手外科杂志,1995,11(9):11-13.
[2] 张延茂,李国华,刘会仁,等.小切口改良Ishiguro法治疗骨性锤状指[J].创伤外科杂志,2010,12(2):173.
[3] Turtle HG,Stma PJ.Tendon avulsion injuries of the distal phalanx[J].Clin Orthop Relat Res,2006,445(3):157-168.
[4] 潘勇卫,田光磊,李淳,等.改良支具固定治疗陈旧腱性锤状指[J].中华手外科杂志,2010,26(6):328-330.
[5] 陈少贞,张涛,朱庆棠,等.两种不同外固定方式对新鲜锤状指临床疗效的单盲随机对照研究[J].中国康复医学杂志,2012,27(11):1006-1010.
[6] Brzezienski MA.Schneider LH.Extensor tendon injuries at the distal interphalangeal joint[J].Hand Clin,1995,11(3):373.
[7] Garberman SF,Diao E,Peimer CA.Mallet finger:results of early versus delayed closed treatment[J].J Hand Surg (Am),1994,19(5):850.
[8] Geyman TP,Fink K,Sullivan SD.Conservative versus surgical treatment of mallet finger: a pooled quantitative literature evaluation[J].J Am Board Fam Pract,1998,11(5):382.
[9] 王树寰.手部创伤的修复[M].北京:北京出版社,1997:204-208.
[10] 顾玉东,王澍寰,侍德.手外科学[M].上海:上海科学技术出版社,2002:492-496.
[11] 刘非,邱冰,薛向东,等.基于3D打印技术的个性化外固定支具设计[J].中国矫形外科杂志,2016,24(24):2260-2263.
[12] 刘广涛,马会力,齐岩,等.3D生物打印技术在骨创伤中的应用进展[J].医学综述,2017,23(7):1291-1295.
[13] 刘建坤,邓术才.3D打印技术在脊柱外科中的地位与作用[J].中国组织工程研究,2017,21(7):1131-1136.
[14] 施劲,王骏.锤状指保守治疗效果及影像因素分析[J].中国康复医学杂志,2017,32(7):826-828.
[15] 陈履平,张诗兴,孙贤敏,等.陈旧性锤状指的显微解剖与治疗研究[J].中华手外科杂志,1994,10(1):34-36.
[16] Patel MR,Desai SS,Bassini-Lipson L.Conservative management of chronic mallet finger[J].J Hand Surg(Am),1986,11(4): 570-573.
[17] 刘志刚,路来金,于家傲.伸肌腱器终腱的形态特点及其临床应用[J].中国临床解剖学杂志,2002,20(2):253-255.
[18] 刘璠,侍德.槌状指的手术治疗[J].中华手外科杂志,1995,11(9):11-13.
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