Department of Orthopedics, Liu Hua Qiao Hospital, Guangzhou, China.
Int Orthop. 2011 Dec;35(12):1827-32. doi: 10.1007/s00264-010-1155-9. Epub 2010 Dec 2.
The correction of severe thoracic deformities is challenging. However, the usual imaging modalities are not sufficient for performing the surgery. Our objective was to describe the procedure and results of posterior modified wedge osteotomy aided by the techniques of computer-aided design-rapid prototyping (CAD-RP) to correct thoracic deformities. Twenty-one patients with thoracic deformities (eight males; 13 females) formed the study group. All patients underwent computed tomography (CT) scanning and CAD-RP, and a model of thoracic deformities and navigation templates of pedicles were created for each patient and used to analyse the spinal deformities and serve as anatomical reference. Aided by these models, personalised modified wedge osteotomy combining the eggshell technique and posterior vertebral column resection was performed. Using CAD-RP improved the safety and accuracy of surgery and screw placement in the 21 patients in whom 41 vertebrae were removed and 216 pedicle screws were placed. The average operation time was 260 (200-420) min, with an average blood loss of 1,900 ml (range 800-3560 ml). The percentage of deformity correction was 56.3% (from 72.1° to 31.5°) in the coronal plane and 60.4% (from 81.6° to 32.3°) in the sagittal plane. No patient had serious complications or implant failure. Personalised single-stage posterior modified wedge osteotomy is an effective procedure for treating thoracic deformities. Using CAD-RP and the RP models have significant benefits for personalised surgical treatment of complex thoracic deformities.
严重的胸壁畸形的矫正具有挑战性。然而，常规的影像学检查手段对于手术治疗来说并不充分。我们的目的是描述在计算机辅助设计-快速成型（CAD-RP）技术辅助下，采用后路改良楔形截骨术矫正胸壁畸形的手术过程和结果。21 例胸壁畸形患者（8 例男性，13 例女性）纳入本研究。所有患者均行 CT 扫描和 CAD-RP，为每位患者创建胸壁畸形模型和椎弓根导航模板，用于分析脊柱畸形并作为解剖学参考。根据这些模型，对患者行个性化改良楔形截骨术，联合蛋壳技术和后路脊柱全长截骨术。通过 CAD-RP 改善了手术的安全性和准确性，21 例患者共切除 41 个椎体，置入 216 枚椎弓根螺钉。手术时间平均 260 分钟（200-420 分钟），平均出血量 1900ml（800-3560ml）。冠状面畸形矫正率为 56.3%（从 72.1°到 31.5°），矢状面畸形矫正率为 60.4%（从 81.6°到 32.3°）。所有患者均未出现严重并发症或植入物失败。个性化单阶段后路改良楔形截骨术是治疗胸壁畸形的有效方法。应用 CAD-RP 和 RP 模型对于复杂胸壁畸形的个体化手术治疗具有重要意义。
