Zhang Lei, Xu Junjie, Tang Xiangyu, Zhou Xin, Li Bingkun, Wang Guoyou
Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.
Center for Orthopedic Diseases Research, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.
Front Bioeng Biotechnol. 2022 Mar 10;10:793866. doi: 10.3389/fbioe.2022.793866. eCollection 2022.
The recommendations for surgical fixation of tibiofibular syndesmosis injuries are increasingly challenging for many clinical orthopedists, as international consensus has not been published for the optimal treatment of the injury. Thus, we have created a 3D-printed navigation template for a precise bone tunnel and a novel adjustable EndoButton fixation (NAE) for the ideal treatment. The purpose of this research was to evaluate the accuracy of the 3D-printed navigation template and explore the biomechanical performance of the NAE technique by comparing it with the intact syndesmosis, screw technique, and TightRope (TR) technique. Twenty-four human cadaveric legs were randomly allocated to four groups: the NAE group ( = 6), TR group ( = 6), screw group ( = 6), and intact group ( = 6). A personalized navigation template based on computed tomography scans was designed, and 3D printing models were generated for the distal tibiofibular syndesmosis. The NAE, TR, and screw group were performed via 3D-printed navigation template, respectively. All groups were tested under increasing loading forces including axial loading (from 100 N to 700 N) and torsional loading (from 1 N to 5 N), which were performed in different ankle positions. The displacements of the tibiofibular syndesmosis were analyzed using the Bose Electroforce 3510-AT biomechanical testing equipment. Surgical fixations were conducted successfully through a 3D-printed navigation template. Both in axial or torsional loading experiments, no statistically significant difference was observed in the displacements among the NAE, TR, and intact groups in most situations ( > 0.05), whereas the screw group demonstrated obviously smaller displacements than the abovementioned three groups ( < 0.05). The 3D printing technology application may become beneficial and favorable for locating and making the bone tunnel. Also, the NAE fixation provides the performance of complete ligaments; it also restores physiologic micromotion and avoids insufficient or excessive reduction when compared to the TR and screw technique. This may offer a new fixation for the treatment of tibiofibular syndesmosis injuries that is desirable for clinical promotion.
对于许多临床骨科医生而言，胫腓下联合损伤的手术固定建议正变得越来越具有挑战性，因为目前尚未发布关于该损伤最佳治疗方法的国际共识。因此，我们制作了一种用于精确骨隧道的3D打印导航模板以及一种用于理想治疗的新型可调式EndoButton固定装置（NAE）。本研究的目的是评估3D打印导航模板的准确性，并通过将NAE技术与完整的下联合、螺钉技术和TightRope（TR）技术进行比较，探索NAE技术的生物力学性能。将24条人体尸体下肢随机分为四组：NAE组（ = 6）、TR组（ = 6）、螺钉组（ = 6）和完整组（ = 6）。基于计算机断层扫描设计了个性化导航模板，并生成了胫腓下联合的3D打印模型。NAE组、TR组和螺钉组分别通过3D打印导航模板进行操作。所有组在不同的踝关节位置承受包括轴向载荷（从100 N到700 N）和扭转载荷（从1 N到5 N）的递增载荷力下进行测试。使用Bose Electroforce 3510 - AT生物力学测试设备分析胫腓下联合的位移。通过3D打印导航模板成功进行了手术固定。在轴向或扭转载荷实验中，在大多数情况下，NAE组、TR组和完整组之间的位移在统计学上没有显著差异（ > 0.05），而螺钉组的位移明显小于上述三组（ < 0.05）。3D打印技术的应用可能有利于定位和制作骨隧道。此外，NAE固定提供了完整韧带的性能；与TR和螺钉技术相比，它还能恢复生理微动并避免复位不足或过度。这可能为胫腓下联合损伤的治疗提供一种新的固定方法，有望在临床上得到推广。
