Byrne Ann-Maria, Impelmans Bianca, Bertrand Veronique, Van Haver Annemieke, Verstreken Frederik
Department of Orthopedic Surgery, Monica Hospital, Antwerp, Belgium.
More Foundation, Antwerp, Belgium.
J Hand Surg Am. 2017 Oct;42(10):836.e1-836.e12. doi: 10.1016/j.jhsa.2017.06.003. Epub 2017 Jul 12.
Three-dimensional planning based on computed tomography images of the malunited and the mirrored contralateral forearm allows preoperative simulations of corrective osteotomies, the fabrication of patient-specific osteotomy guides, and custom-made 3-dimensional printed titanium plates. This study aims to assess the precision and clinical outcome of this technique.
This was a prospective pilot study with 5 consecutive patients. The mean age at initial injury was 11 years (range, 4-16 years), and the mean interval from the time of injury to the time of corrective surgery was 32 months (range, 7-107 months). Patient-specific osteotomy guides and custom-made plates were used for multiplanar corrective osteotomies of both forearm bones at the distal level in 1 patient and at the middle-third level in 4 patients. Patients were assessed before and after surgery after a mean follow-up of 42 months (range, 29-51 months).
The mean planned angular corrections of the ulna and radius before surgery were 9.9° and 10.0°, respectively. The mean postoperative corrections obtained were 10.1° and 10.8° with corresponding mean errors in correction of 1.8° (range, 0.3°-5.2°) for the ulna and 1.4° (range, 0.2°-3.3°) for the radius. Forearm supination improved significantly from 47° (range, 25°-75°) before surgery to 89° (range, 85°-90°) at final review. Forearm pronation improved from 68° (range, 45°-84°) to 87° (range, 82°-90°). In addition, there was a statistically significant improvement in pain and grip strength.
This study demonstrates that 3-dimensional planned patient-specific guides and implants allow the surgeon to perform precise corrective osteotomies of complex multiplanar forearm deformities with satisfactory preliminary results.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic V.
基于畸形愈合的前臂和镜像对侧前臂的计算机断层扫描图像进行三维规划，可在术前模拟截骨矫正，制作患者特异性截骨导板，并定制三维打印钛板。本研究旨在评估该技术的精度和临床效果。
这是一项对5例连续患者进行的前瞻性初步研究。初次受伤时的平均年龄为11岁（范围4 - 16岁），从受伤到矫正手术的平均间隔时间为32个月（范围7 - 107个月）。1例患者在前臂远端水平、4例患者在前臂中1/3水平使用患者特异性截骨导板和定制钢板进行双侧前臂骨的多平面截骨矫正。平均随访42个月（范围29 - 51个月）后对患者进行手术前后评估。
术前尺骨和桡骨计划的平均角度矫正分别为9.9°和10.0°。术后获得的平均矫正角度分别为10.1°和10.8°，尺骨相应的平均矫正误差为1.8°（范围0.3° - 5.2°），桡骨为1.4°（范围0.2° - 3.3°）。前臂旋后从术前的47°（范围25° - 75°）显著改善至末次复查时的89°（范围85° - 90°）。前臂旋前从68°（范围45° - 84°）改善至87°（范围82° - 90°）。此外，疼痛和握力有统计学意义的改善。
本研究表明，三维规划的患者特异性导板和植入物使外科医生能够对复杂的多平面前臂畸形进行精确的截骨矫正，初步结果令人满意。
研究类型/证据水平：治疗性V。
