Fellow, Foot and Ankle Institute, Indianapolis, IN.
Program Director, Foot & Ankle Residency Training Program, West Penn Hospital, Allegheny Health Network, Pittsburgh, PA.
J Foot Ankle Surg. 2021 Jul-Aug;60(4):824-833. doi: 10.1053/j.jfas.2020.08.011. Epub 2020 Aug 15.
Periarticular osseous defects pose a challenge when considering arthrodesis. Failure to restore the cubic content of bone can result in shortening and malalignment, as well as subsequent biomechanical issues. This study reports on 12 patients treated with patient-specific 3-D printed (7) and prefabricated titanium trusses (5). Twelve consecutive patients were treated for osseous defects of the forefoot, hindfoot, and ankle with patient-specific, 3D printed or prefabricated manufacturer titanium trusses. Seven were customized, patient-specific 3D printed trusses (4WEB, Frisco, Texas) and 5 were prefabricated manufacturer titanium trusses. All patients had a minimum of 6 months of clinical and radiographic follow-up. and no patients were lost to follow-up. Seven of the 12 patients had a computed tomography (CT) scan performed following surgery. Successful limb or ray salvage was achieved in 11 of 12 patients (91.7%). Six of 7 patients (85.7%) with a postoperative CT scan, went on to complete radiographic consolidation across all arthrodesis sites. The remaining 5 patients showed complete consolidation across the arthrodesis sites on plain film radiographs. Complications included one patient with a residual midfoot deformity that required a subsequent midfoot osteotomy in order to obtain a plantigrade foot following successful tibiotalocalcaneal (TTC) arthrodesis, and a below knee amputation in one patient who underwent revision TTC arthrodesis to salvage avascular necrosis of the talus that developed following the index procedure. Eleven of 12 patients undergoing arthrodesis demonstrated successful union with both customized, patient-specific 3D printed and prefabricated manufacturer titanium trusses on CT scans or radiographs. The average follow-up was 14 months. Reports on traditional methods of addressing periarticular defects in patients requiring arthrodesis show mixed results and relatively high complication rates. Custom, 3D printed and prefabricated titanium truss technology offers an alternative to traditional methods for large, periarticular osseous defects.
当考虑关节融合时，关节周围骨缺损是一个挑战。如果不能恢复骨的立方容积，可能会导致缩短和对线不良，以及随后的生物力学问题。本研究报告了 12 例接受患者特异性 3D 打印（7 例）和预制钛桁架（5 例）治疗的患者。连续 12 例患者因前足、后足和踝关节的骨缺损接受了患者特异性、3D 打印或预制制造商钛桁架治疗。7 例为定制的、患者特异性的 3D 打印桁架（4WEB，德克萨斯州弗里斯科），5 例为预制制造商钛桁架。所有患者均获得至少 6 个月的临床和影像学随访，无患者失访。12 例患者中的 7 例在手术后进行了计算机断层扫描（CT）检查。12 例患者中有 11 例（91.7%）实现了肢体或射线的成功保存。6 例（85.7%）接受术后 CT 扫描的患者，所有关节融合部位均完全融合。其余 5 例患者在普通 X 线片上显示关节融合部位完全融合。并发症包括 1 例患者存在中足残余畸形，需要行中足截骨术，以使成功的距下跟骨（TTC）关节融合后获得跖行足；1 例患者行 TTC 关节融合翻修术，以挽救在指数手术后发生的距骨缺血性坏死，导致膝下截肢。12 例接受关节融合术的患者中有 11 例在 CT 扫描或 X 线片上显示使用定制的、患者特异性的 3D 打印和预制制造商钛桁架成功融合。平均随访时间为 14 个月。关于需要关节融合的患者关节周围缺陷的传统治疗方法的报告显示结果不一，且并发症发生率相对较高。定制的、3D 打印和预制的钛桁架技术为治疗大的关节周围骨缺损提供了一种替代传统方法。
