用 3D 钛植入物进行肩关节置换术治疗肩腰部严重枪伤的早期结果

Stanislav Bondarenko, Oleksandr Fomin, Iurii Lazarenko
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In 2022–2023, 19 men aged 36.2 (24–52) years with severe combat trauma of the upper extremity underwent shoulder arthrodesis using individual 3D-titanium implants (n = 9) or LCP with bone autoplasty (n = 10). The follow-up period was 18 months. Individual 3D-implants were created in the CAD program Autodesk Fusion 360 and made of Ti6AI4V alloy by three- dimensional metal 3D-printing. The functional status of the shoulder joint was assessed by the Oxford Shoulder Score, VAS at 6 and 12 months after surgery. Fusion was checked radiographically at 1, 3, 6 and 12 months. Results. The average follow-up period was 12 months. Ankylosis of the shoulder joint was formed in 18 (95 %) patients, and clinical consolidation without final restructuring with a positive tendency to bone fusion was detected in one patient (5 %). Radiologically confirmed fusion in 8.5 months (6–12). 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引用次数: 0

摘要

由于乌克兰发生了大规模战争,上肢枪伤的发生率急剧上升,并伴有软组织、神经血管丛的大量损伤和严重的骨缺损,因此用传统方法治疗具有很大风险。因此,需要开发新的治疗方法,特别是肩关节置换技术。目的研究使用单个三维钛植入物和锁定加压板(LCP)以及骨自体成形术治疗上肢严重战斗创伤的肩关节置换术的有效性。研究方法2022-2023年,19名年龄在36.2(24-52)岁的上肢严重战斗创伤男性接受了肩关节置换术,使用单个三维钛植入物(9人)或带骨自体成形术的LCP(10人)。随访期为 18 个月。单个三维植入物是在 CAD 程序 Autodesk Fusion 360 中创建的,通过三维金属三维打印技术由 Ti6AI4V 合金制成。术后 6 个月和 12 个月,通过牛津肩关节评分和 VAS 评估肩关节的功能状态。术后1、3、6和12个月时对融合情况进行放射学检查。结果。平均随访时间为 12 个月。18名患者(95%)出现了肩关节强直,1名患者(5%)出现了临床巩固,但没有最终重组,骨融合趋势良好。8.5个月后(6-12个月),经放射学检查确认骨融合。与 6 个月相比,12 个月后疼痛减轻(VAS:5 至 1 分;P < 0.001),肩部状况有所改善(牛津肩部评分:25 至 40 分;P < 0.001)。结论通过肩关节置换术治疗上肢的严重战斗创伤可以消除疼痛,并在术后一年恢复足够的功能来完成日常工作。将肩关节置换术与单个三维假体相结合,可使所有9名有大量骨骼和肌肉缺损的患者恢复上肢功能。
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EARLY RESULTS OF SHOULDER ARTHRODESIS WITH 3D-TITANIUM IMPLANTS FOR TREATMENT OF SEVERE GUNSHOT WOUNDS OF THE SHOULDER GIRDLE
As a result of large-scale war in Ukraine, the frequency of gunshot wounds of the upper extremities has increased dramatically, accompanied by massive damage to soft tissue, neurovascular plexuses, and significant bone deficiency, so their treatment with traditional methods is risky. This leads to the development of new treatment methods, in particular, techniques for shoulder arthrodesis. Objective. To investigate the effectiveness of shoulder arthrodesis using an individual 3D-titanium implant and or a locked compression plate (LCP) with bone autoplasty for the treatment of severe combat trauma of the upper extremity. Methods. In 2022–2023, 19 men aged 36.2 (24–52) years with severe combat trauma of the upper extremity underwent shoulder arthrodesis using individual 3D-titanium implants (n = 9) or LCP with bone autoplasty (n = 10). The follow-up period was 18 months. Individual 3D-implants were created in the CAD program Autodesk Fusion 360 and made of Ti6AI4V alloy by three- dimensional metal 3D-printing. The functional status of the shoulder joint was assessed by the Oxford Shoulder Score, VAS at 6 and 12 months after surgery. Fusion was checked radiographically at 1, 3, 6 and 12 months. Results. The average follow-up period was 12 months. Ankylosis of the shoulder joint was formed in 18 (95 %) patients, and clinical consolidation without final restructuring with a positive tendency to bone fusion was detected in one patient (5 %). Radiologically confirmed fusion in 8.5 months (6–12). After 12 months, a decrease in pain (VAS: 5 to 1 points; p < 0.001) and improvement in the condition of the shoulder (Oxford Shoulder Score: 25 to 40 points, p < 0.001) were found compared with 6 months. Conclusions. Treatment of severe combat trauma of the upper extremity by shoulder arthrodesis allows to eliminate pain and restore sufficient function to perform daily tasks one year after surgery. The combination of shoulder arthrodesis with individual 3D-implants resulted in the restoration of upper limb function in all 9 patients with massive bone and muscle defects.
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