Department of Pediatric Orthopedic Surgery, Dana Dwek Children's Hospital.
National Unit of Orthopedic Oncology.
J Pediatr Orthop. 2022;42(5):e427-e434. doi: 10.1097/BPO.0000000000002104.
Three-dimensional (3D) virtual surgical planning technology has advanced applications in the correction of deformities of long bones by enabling the production of 3D stereolithographic models, patient-specific instruments and surgical-guiding templates. Herein, we describe the implementation of this technology in young patients who required a corrective osteotomy for a complex 3-plane (oblique plane) lower-limb deformity.
A total of 17 patients (9 males, average age 14.7 y) participated in this retrospective study. As part of preoperative planning, the patients' computerized tomographic images were imported into a post-processing software, and virtual 3D models were created by a segmentation process. Femoral and tibial models and cutting guides with locking points were designed according to the deformity correction plan. They were used for both planning and as intraoperative guides. Clinical parameters, such as blood loss and operative time were compared with a traditional surgical approach group.
All osteotomies in the 3D group were executed with the use intraoperative customized cutting guides which matched the preoperative planning simulation and allowed easy fixation with prechosen plates. Surgical time was 101±6.2 minutes for the 3D group and 126.4±16.1 minutes for the control group. The respective intraoperative hemoglobin blood loss was 2.1±0.2 and 2.5+0.3 g/dL.Clinical and radiographic follow-up findings showed highly satisfactory alignment of the treated extremities in all 3D intervention cases, with an average time-to-bone union (excluding 2 neurofibromatosis 1 patients) of 10.3 weeks (range 6 to 20 wk).
The use of 3D-printed models and patient-specific cutting guides with locking points improves the clinical outcomes of osteotomies in young patients with complex bone deformities of the lower limbs.
Level III.
三维（3D）虚拟手术规划技术通过制作 3D 立体光刻模型、患者特异性器械和手术引导模板，在长骨畸形矫正中具有广泛的应用。在此，我们描述了该技术在需要进行复杂三平面（斜平面）下肢畸形矫正的年轻患者中的应用。
共有 17 名患者（9 名男性，平均年龄 14.7 岁）参与了这项回顾性研究。作为术前规划的一部分，患者的计算机断层扫描图像被导入后处理软件，通过分割过程创建虚拟 3D 模型。根据畸形矫正计划设计股骨和胫骨模型以及带有锁定点的截骨导板。这些导板既用于规划，也用于术中引导。与传统手术方法组相比，比较了临床参数，如失血量和手术时间。
3D 组的所有截骨术均使用术中定制的截骨导板完成，这些导板与术前规划模拟相匹配，便于用预先选择的钢板固定。3D 组的手术时间为 101±6.2 分钟，对照组为 126.4±16.1 分钟。术中血红蛋白失血量分别为 2.1±0.2 和 2.5+0.3 g/dL。临床和影像学随访结果显示，所有 3D 干预病例中治疗肢体的对线均非常满意，平均骨愈合时间（不包括 2 例神经纤维瘤病 1 型患者）为 10.3 周（6 至 20 周）。
使用 3D 打印模型和带有锁定点的患者特异性截骨导板可改善下肢复杂骨畸形年轻患者截骨术的临床结果。
III 级。
