Department of Biomedical Engineering and Physics, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Room No L0-113-3, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
Int J Comput Assist Radiol Surg. 2021 Mar;16(3):515-524. doi: 10.1007/s11548-021-02320-5. Epub 2021 Feb 11.
Corrective osteotomy of a malunited distal radius conventionally relies on 2D imaging techniques for alignment planning and evaluation. However, this approach results in suboptimal bone repositioning, which is associated with poor patient outcomes. In this case series, we evaluate the use of novel patient-specific plates (PSPs), which feature navigation and fixation of bone segments as preoperatively planned in 3D.
Ten participants with distal radius malunion underwent CT scans for preoperative alignment planning. Patient-specific guides and plates were designed, 3D-printed, and sterilized for use in corrective surgery of the distal radius. Pre- and postoperative results were compared in regard to clinical, functional, and radiographic outcomes.
The application of a PSP was successful in 7 of the 10 cases. After treatment, the residual alignment error was reduced by approximately 50% compared with conventional treatment. The use of PSPs reduced pain significantly. Pre- and postoperative results were pooled and demonstrated significant correlations between: (1) pain and malpositioning, (2) the range of pro- and supination motion, the MHOQ score, the EQ-5D-5L score and dorsovolar angulation, and (3) MHOQ score and proximodistal translation.
The correlation between malalignment and MHOQ score, EQ-5D-5L score, pain, and range of motion shows that alignment should be restored as well as possible. Compared to the conventional approach, which relies on 2D imaging techniques, corrective osteotomy based on 3D preoperative planning and intraoperative fixation with a PSP has been shown to improve bone alignment and reduce pain.
IV.
传统的桡骨远端畸形愈合矫正术依赖于二维成像技术进行对线规划和评估。然而，这种方法导致骨复位不理想，从而导致患者预后不佳。在本病例系列中，我们评估了新型个体化钢板（PSP）的应用，该钢板具有导航和固定术前计划的三维骨段的功能。
10 例桡骨远端畸形愈合患者行 CT 扫描进行术前对线规划。设计、3D 打印并消毒个体化导向器和钢板，用于桡骨远端矫正手术。比较术前和术后的临床、功能和影像学结果。
10 例患者中有 7 例成功应用 PSP。与常规治疗相比，治疗后残余对线误差减少了约 50%。PSP 的应用显著减轻了疼痛。将术前和术后结果汇总后，发现疼痛和错位、掌屈和背伸活动范围、MHOQ 评分、EQ-5D-5L 评分和背侧/掌侧成角、MHOQ 评分和近/远侧移位之间存在显著相关性。
对线不良与 MHOQ 评分、EQ-5D-5L 评分、疼痛和活动范围之间的相关性表明，应尽可能恢复对线。与依赖二维成像技术的传统方法相比，基于三维术前规划和 PSP 术中固定的矫正性截骨术已被证明可改善骨对线并减轻疼痛。
IV 级。
