Orthopedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zürich-CH, Switzerland.
ROCS; Research in Orthopedic Computer Science, Balgrist University Hospital, University of Zurich, Balgrist-Campus, Lengghalde 5, 8008, Zurich-CH, Switzerland.
Arch Orthop Trauma Surg. 2021 Aug;141(8):1425-1432. doi: 10.1007/s00402-021-03856-6. Epub 2021 Mar 14.
Intra-articular fractures are associated with posttraumatic arthritis if inappropriately treated. Exact reduction of the joint congruency is the main factor to avoid the development of arthrosis. Aim of this study was to evaluate feasibility of computer-assisted surgical planning and 3D-printed patient-specific instrumentation (PSI) for treatment of distal intraarticular radius fractures.
7 Patients who suffered a distal intraarticular radius fracture were enrolled in this prospective case series. Preoperative CT-scan was recorded, whereupon a 3D model was computed for surgical planning and design of PSI for surgical navigation. Postoperative accuracy and joint congruency were assessed. Patients were followed-up 3, 6 and 12 months postoperatively.
Mean follow-up was 16 months. Over all range of motion was restored and flexion, extension and pronation showed significant recovery, p < 0.05. Biggest intraarticular joint step-off and gap reduced from average 2.49 (± 1.04) to 0.8 mm (± 0.44), p < 0.05 and 6.12 mm (± 1.04) to 2.21 mm (± 1.16), p < 0.05. Average grip strength restored (3-16 months) from 20.33 kg (± 7.12) to 39.3 kg (± 19.55) p < 0.05, 100% of the healthy contralateral side. 3D-accuracy for guided fragments was 2.07 mm (± 0.64) and 8.59° (± 2.9) and 2.33 mm (± 0.69) and 12.86° (± 7.13), p > 0.05 for fragments reduced with ligamentotaxis.
Computer-assisted and PSI navigated intraarticular radius fracture treatment is feasible, safe and accurate. The benefits of this method, however, do not outstand the additional effort.
IV.
关节内骨折如果治疗不当，会导致创伤后关节炎。准确恢复关节的一致性是避免关节炎发展的主要因素。本研究旨在评估计算机辅助手术规划和 3D 打印患者特异性器械 (PSI) 在治疗关节内桡骨远端骨折中的可行性。
本前瞻性病例系列研究纳入了 7 例关节内桡骨远端骨折患者。记录术前 CT 扫描，计算 3D 模型进行手术规划和 PSI 设计用于手术导航。评估术后的准确性和关节一致性。患者在术后 3、6 和 12 个月进行随访。
平均随访时间为 16 个月。所有的活动范围都得到了恢复，屈曲、伸展和旋前都有显著的恢复，p<0.05。最大的关节内关节台阶和间隙从平均 2.49(±1.04)减少到 0.8mm(±0.44)，p<0.05 和 6.12mm(±1.04)减少到 2.21mm(±1.16)，p<0.05。平均握力从 20.33kg(±7.12)恢复到 39.3kg(±19.55)，p<0.05，达到健侧的 100%。引导骨块的 3D 精度为 2.07mm(±0.64)和 8.59°(±2.9)，8.59°(±2.9)和 12.86°(±7.13)，p>0.05，用于韧带固定的骨块。
计算机辅助和 PSI 导航关节内桡骨远端骨折治疗是可行的、安全的和准确的。然而，这种方法的好处并不明显。
IV。
