Bauer Andrea S, Storelli Dora A R, Sibbel Sarah E, McCarroll H Relton, Lattanza Lisa L
*Boston Children's Hospital, Boston, MA †Shriners Hospitals for Children-Northern California, Sacramento, CA ‡Children's Hospital Colorado, Aurora, CO.
J Pediatr Orthop. 2017 Oct/Nov;37(7):504-510. doi: 10.1097/BPO.0000000000000673.
Posttraumatic and congenital forearm deformities in children can be difficult to appreciate in all planes. In cases of distal radioulnar joint instability and loss of forearm rotation, surgical correction is challenging. Advances in 3-dimensional printing allow creation of custom guides at a reasonable cost, enabling precise correction of the deformity in all planes.
Nineteen children with deformity of the forearm had corrective osteotomies performed using preoperative 3-dimensional computer modeling and patient-specific surgical guides. Surgicase software was used for 3-dimensional planning of the corrective osteotomy, by superimposing a mirror image of the unaffected side as a template. Based upon this planning, patient-specific surgical guides were manufactured. Radiographic and clinical outcomes were assessed.
Three patients had a diagnosis of multiple hereditary exostoses, and one of Madelung's deformity. The remaining 15 patients had a diagnosis of fracture malunion. Average preoperative angulation of both the radius and ulna was 23 degrees. For the patients with fracture malunions, the time from injury to surgery ranged from 6 months to 8 years. Twelve patients underwent osteotomies of both the radius and ulna, 5 had osteotomies of the radius alone, and 2 had a single osteotomy of the ulna only. All osteotomies went on to unite and no patient lost range of motion. Preoperative arc of forearm rotation averaged 101 degrees (range 0 to 180 degrees). Postoperatively, this improved to 133 degrees (range 85 to 180 degrees). Eight patients had distal radioulnar instability preoperatively, all of which normalized after surgery. There were 4 complications: 1 hypertrophic scar, 1 subject with extensor pollicis longus weakness, and 2 transient sensory losses in the superficial radial nerve distribution.
This case series demonstrates that 3-dimensional computer modeling permits complex and multiple osteotomies to be done safely to achieve deformity correction in children. Limitations in forearm rotation and distal radioulnar malalignment can be reliably improved using this technique.
Level IV-retrospective case series.
儿童创伤后和先天性前臂畸形在所有平面上可能都难以评估。在桡尺远侧关节不稳定和前臂旋转功能丧失的情况下，手术矫正具有挑战性。三维打印技术的进步使得能够以合理的成本制作定制导板，从而在所有平面上精确矫正畸形。
19例前臂畸形儿童接受了使用术前三维计算机建模和患者特异性手术导板的截骨矫正手术。使用Surgicase软件通过将未受影响侧的镜像作为模板进行截骨矫正的三维规划。基于此规划，制作了患者特异性手术导板。评估了影像学和临床结果。
3例患者诊断为多发性遗传性骨软骨瘤，1例为马德隆畸形。其余15例患者诊断为骨折不愈合。桡骨和尺骨术前平均成角为23度。对于骨折不愈合患者，受伤至手术的时间为6个月至8年。12例患者同时进行了桡骨和尺骨截骨，5例仅进行了桡骨截骨，2例仅进行了尺骨单截骨。所有截骨均愈合，无患者出现活动范围丧失。术前前臂旋转弧平均为101度（范围0至180度）。术后，这一数值改善至133度（范围85至180度）。8例患者术前存在桡尺远侧不稳定，术后均恢复正常。有4例并发症：1例肥厚性瘢痕，1例拇长伸肌无力，2例桡浅神经分布区短暂感觉丧失。
该病例系列表明，三维计算机建模允许安全地进行复杂和多处截骨，以实现儿童畸形矫正。使用该技术可可靠地改善前臂旋转受限和桡尺远侧排列不齐的情况。
IV级——回顾性病例系列。
Zotero 插件