Murase Tsuyoshi, Takeyasu Yukari, Oka Kunihiro, Kataoka Toshiyuki, Tanaka Hiroyuki, Yoshikawa Hideki
Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita 565-0871, Osaka, Japan. E-mail address for T. Murase:
JBJS Essent Surg Tech. 2014 Mar 26;4(1):e6. doi: 10.2106/JBJS.ST.M.00044. eCollection 2014 Mar.
We present a detailed description of our preoperative planning and surgical technique for three-dimensional (3-D) corrective osteotomy with use of custom-made surgical guides for cubitus varus deformity after supracondylar fracture.
STEP 1 CREATE COMPUTER BONE MODELS FROM CT DATA: Obtain CT data of both upper extremities and create computer bone models from these data.
STEP 2 EVALUATE THE 3-D DEFORMITY: Evaluate the deformity in three dimensions by comparing the affected humerus with the mirror image of the contralateral, normal humerus.
STEP 3 PLAN THE 3-D CORRECTIVE OSTEOTOMY: Simulate a 3-D corrective osteotomy on the basis of information obtained from the deformity evaluation.
STEP 4 OPERATIVE SETUP: Order the custom-made surgical guides that will assist you in reproducing the preoperative simulation during the actual surgery.
STEP 5 PERFORM THE 3-D OSTEOTOMY USING THE CUSTOM-MADE SURGICAL GUIDES: Perform the osteotomy using the custom-made surgical guides and achieve anatomical correction using the reduction guides.
STEP 6 POSTOPERATIVE CARE: Apply a removable splint and have the patient start active and passive range-of-motion exercise after the splinting period has been completed.
In our series of thirty patients, the mean humerus-elbow-wrist angle and tilting angle of the affected side were 18° (varus) and 25°, respectively, before surgery, which significantly improved to 6° (valgus) and 38°, respectively, after surgery.IndicationsContraindicationsPitfalls & Challenges.
我们详细描述了使用定制手术导板进行三维（3-D）矫正截骨术治疗髁上骨折后肘内翻畸形的术前规划和手术技术。
步骤1：从CT数据创建计算机骨骼模型：获取双上肢的CT数据，并根据这些数据创建计算机骨骼模型。
步骤2：评估三维畸形：通过将患侧肱骨与对侧正常肱骨的镜像进行比较，从三个维度评估畸形情况。
步骤3：规划三维矫正截骨术：根据畸形评估获得的信息模拟三维矫正截骨术。
步骤4：手术准备：订购定制手术导板，这将有助于你在实际手术中重现术前模拟。
步骤5：使用定制手术导板进行三维截骨术：使用定制手术导板进行截骨术，并使用复位导板实现解剖学矫正。
步骤6：术后护理：应用可拆除夹板，夹板固定期结束后让患者开始进行主动和被动活动范围练习。
在我们的30例患者系列中，患侧术前平均肱骨-肘-腕角和倾斜角分别为18°（内翻）和25°，术后分别显著改善为6°（外翻）和38°。适应证、禁忌证、陷阱与挑战。
