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犬前臂畸形的计算机辅助手术矫正

Computer-assisted surgical correction of an antebrachial deformity in a dog.

作者信息

Crosse K R, Worth A J

机构信息

Massey University Veterinary Teaching Hospital, Palmerston North, Manawatu, New Zealand.

出版信息

Vet Comp Orthop Traumatol. 2010;23(5):354-61. doi: 10.3415/VCOT-10-01-0010. Epub 2010 Aug 25.

Abstract

OBJECTIVE

To report the use of three dimensional (3D) computed tomographic (CT) imaging, computer simulation and rapid prototype modelling to aid surgical correction of a complex antebrachial deformity in a dog.

METHODS

A six-year-old, 13 kg spayed female Chihuahua crossbreed dog was presented for worsening forelimb gait and exercise intolerance. Both forelimbs had gross angular limb deformity with carpal hyper-flexion, valgus and radial procurvatum. Surgical planning from radiographs was problematic therefore CT data were used to generate 3D reconstructions of the antebrachium. Using imaging software we then quantified the nature of the deformity using a previously unreported method based on the centre of rotation of angulation as a 3D model. Computer simulated closing of the virtual wedge osteotomy was then performed as proof of concept. A stereolithographic model complete with osteotomy axes, was then created in plastic using a rapid prototyping machine. Oscillating saw guides were fabricated in polymethylmethacrylate and cold sterilised. A closing wedge osteotomy with de-rotation was performed and stabilised with a pre-contoured dynamic compression plate. At the three- and six-month follow-up examinations there was improved weight-bearing and cosmetic appearance.

CONCLUSIONS

Computer assistance was valuable for locating and quantifying this antebrachial deformity and conceptualising the corrective surgery. The results of our study suggest that rapid prototyping can be used to create models and saw guides to simplify one-stage corrective osteotomies and more accurately treat angular limb deformity.

摘要

目的

报告使用三维(3D)计算机断层扫描(CT)成像、计算机模拟和快速原型建模辅助矫正犬复杂前臂畸形的情况。

方法

一只6岁、体重13千克的绝育雌性吉娃娃杂交犬因前肢步态恶化和运动不耐受前来就诊。双侧前肢均有严重的肢体成角畸形,伴有腕关节过度屈曲、外翻和桡骨前凸。基于X线片进行手术规划存在困难,因此使用CT数据生成前臂的3D重建图像。然后,我们使用成像软件,基于作为3D模型的成角旋转中心,采用一种此前未报道的方法对畸形的性质进行量化。接着进行计算机模拟闭合虚拟楔形截骨术,作为概念验证。随后,使用快速成型机制作出带有截骨轴线的立体光刻模型。用聚甲基丙烯酸甲酯制作摆动锯导板并进行冷灭菌处理。实施闭合楔形截骨术并进行去旋转,用预塑形的动力加压钢板进行固定。在术后3个月和6个月的随访检查中,发现负重情况和外观均有改善。

结论

计算机辅助对于定位和量化这种前臂畸形以及构思矫正手术很有价值。我们的研究结果表明,快速原型制作可用于创建模型和锯导板,以简化一期矫正截骨术并更准确地治疗肢体成角畸形。

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