Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.
Clin Orthop Relat Res. 2011 Jun;469(6):1766-73. doi: 10.1007/s11999-010-1748-z. Epub 2011 Jan 4.
Corrective osteotomy using dorsal plates and structural bone graft usually has been used for treating symptomatic distal radius malunions. However, the procedure is technically demanding and requires an extensive dorsal approach. Residual deformity is a relatively frequent complication of this technique.
QUESTIONS/PURPOSES: We evaluated the clinical applicability of a three-dimensional osteotomy using computer-aided design and manufacturing techniques with volar locking plates for distal radius malunions.
Ten patients with metaphyseal radius malunions were treated. Corrective osteotomy was simulated with the help of three-dimensional bone surface models created using CT data. We simulated the most appropriate screw holes in the deformed radius using computer-aided design data of a locking plate. During surgery, using a custom-made surgical template, we predrilled the screw holes as simulated. After osteotomy, plate fixation using predrilled screw holes enabled automatic reduction of the distal radial fragment. Autogenous iliac cancellous bone was grafted after plate fixation.
The median volar tilt, radial inclination, and ulnar variance improved from -20°, 13°, and 6 mm, respectively, before surgery to 12°, 24°, and 1 mm, respectively, after surgery. The median wrist flexion improved from 33° before surgery to 60° after surgery. The median wrist extension was 70° before surgery and 65° after surgery. All patients experienced wrist pain before surgery, which disappeared or decreased after surgery.
Surgeons can operate precisely and easily using this advanced technique. It is a new treatment option for malunion of distal radius fractures.
使用背侧钢板和结构性骨移植进行矫正性截骨术通常用于治疗有症状的桡骨远端愈合不良。然而，该手术技术要求高，需要广泛的背侧入路。残留畸形是该技术相对常见的并发症。
问题/目的：我们评估了使用计算机辅助设计和制造技术与掌侧锁定板治疗桡骨远端愈合不良的三维截骨术的临床适用性。
10 例骨干愈合不良的患者接受了治疗。使用 CT 数据创建的三维骨表面模型来模拟矫正性截骨术。我们使用锁定板的计算机辅助设计数据模拟了变形桡骨中最合适的螺钉孔。在手术中，使用定制的手术模板，我们预先钻了模拟的螺钉孔。截骨术后，使用预钻孔的螺钉孔固定钢板可自动复位桡骨远端碎片。在钢板固定后，自体髂骨松质骨被移植。
掌倾角、桡骨倾斜度和尺侧偏移中位数分别从术前的-20°、13°和 6mm 改善至术后的 12°、24°和 1mm。术前腕关节屈曲度中位数为 33°，术后为 60°。术前腕关节伸展度中位数为 70°，术后为 65°。所有患者术前均有腕部疼痛，术后疼痛消失或减轻。
外科医生可以使用这项先进技术进行精确和轻松的手术。这是治疗桡骨远端骨折愈合不良的一种新的治疗选择。
