Zheng Hao, Wang Lili, Jiang Wenbo, Qin Ruiqing, Zhang Zhiyu, Jia Zhuqing, Zhang Jian, Liu Yong, Gao Xuejian
Department of Trauma Surgery, Affiliated Hospital of Weifang Medical University, Weifang, China.
School of Clinical Medicine, Weifang Medical University, Weifang, China.
Front Surg. 2023 Jan 6;9:985110. doi: 10.3389/fsurg.2022.985110. eCollection 2022.
The Ilizarov technique of distraction osteogenesis is an effective treatment for tibia defect. However, repeated attempts to reduce due to the complexity of the bone defect during the operation will increase the operation time and iatrogenic injury, and excessive radiation exposure. Three-dimensional (3D)-printed patient-specific instrument (PSI) for preoperative 3D planning and intraoperative navigation have the advantages of accuracy and visualization. The purpose of this study is to investigate whether 3D-printed PSI is helpful to correct tibial bone defects accurately and effectively.
From May 2019 to September 2022, 19 patients with tibial bone defects were treated, including 9 males and 10 females, aged 37 to 64 years. There were 4 cases in proximal tibia, 9 in midshaft tibia and 6 in distal tibia. All were treated with Ilizarov technique of distraction osteogenesis. 3D-printed PSI was used in 9 cases, while traditional surgery was used in 10 cases. All patients underwent computed tomography before surgery. Computer software was used to analyze the measurement results, design and print PSI. During the operation, PSI was used to assist in reduction of tibia. Operation times were recorded in all cases, the number of fluoroscopy during the operation, and the varus/valgus, anteversion/reversion angle after the operation were measured. All measurement data were expressed by means ± SD, and Student's t test was used to examine differences between groups. The chi square test or Fisher's precise test was used to compare the counting data of the two groups.
All PSI matched well with the corresponding tibia bone defect, and were consistent with the preoperative plan and intraoperative operation. The affected limb had a good reduction effect. The operation time from the beginning of PSI installation to the completion of Ilizarov ring fixator installation was 31.33 ± 3.20 min, while that in the traditional operation group was 64.10 ± 6.14 min ( < 0.001). The times of fluoroscopy in the PSI group during operation was 10.11 ± 1.83, and that in the traditional operation group was 27.60 ± 5.82. The reduction effect of tibia in PSI group was better than that in traditional operation group, with the average angle of PSI group is 1.21 ± 0.24°, and that of traditional operation group is 2.36 ± 0.33° ( < 0.001).
The PSI simplifies procedures, reduces the difficulty of the operation, improves the accuracy of the operation, and provides a good initial position when used in distraction osteogenesis to treat the tibial defects.
伊利扎洛夫牵张成骨技术是治疗胫骨缺损的有效方法。然而，由于手术中骨缺损的复杂性，反复尝试复位会增加手术时间、医源性损伤以及辐射暴露。用于术前三维（3D）规划和术中导航的3D打印患者特异性器械（PSI）具有准确性和可视化的优点。本研究的目的是探讨3D打印PSI是否有助于准确、有效地矫正胫骨骨缺损。
2019年5月至2022年9月，治疗19例胫骨骨缺损患者，其中男性9例，女性10例，年龄37至64岁。胫骨近端4例，胫骨干9例，胫骨远端6例。均采用伊利扎洛夫牵张成骨技术治疗。9例使用3D打印PSI，10例采用传统手术。所有患者术前均行计算机断层扫描。使用计算机软件分析测量结果，设计并打印PSI。术中使用PSI辅助胫骨复位。记录所有病例的手术时间、术中透视次数，并测量术后内翻/外翻、前倾/后倾角度。所有测量数据以均数±标准差表示，采用Student's t检验比较组间差异。采用卡方检验或Fisher精确检验比较两组的计数资料。
所有PSI与相应胫骨骨缺损匹配良好，与术前规划和术中操作一致。患肢复位效果良好。从安装PSI开始到完成伊利扎洛夫环形固定器安装的手术时间为31.33±3.20分钟，而传统手术组为64.10±6.14分钟（P<0.001）。PSI组术中透视次数为10.11±1.83次，传统手术组为27.60±5.82次。PSI组胫骨复位效果优于传统手术组，PSI组平均角度为1.21±0.24°，传统手术组为2.36±0.33°（P<0.001）。
PSI简化了手术步骤，降低了手术难度，提高了手术准确性，在牵张成骨治疗胫骨缺损时提供了良好的初始位置。
