Assink Nick, Ten Duis Kaj, de Vries Jean-Paul P M, Witjes Max J H, Kraeima Joep, Doornberg Job N, IJpma Frank F A
Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
3D Lab, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
Bone Jt Open. 2024 Jan 19;5(1):46-52. doi: 10.1302/2633-1462.51.BJO-2023-0130.R1.
Proper preoperative planning benefits fracture reduction, fixation, and stability in tibial plateau fracture surgery. We developed and clinically implemented a novel workflow for 3D surgical planning including patient-specific drilling guides in tibial plateau fracture surgery.
A prospective feasibility study was performed in which consecutive tibial plateau fracture patients were treated with 3D surgical planning, including patient-specific drilling guides applied to standard off-the-shelf plates. A postoperative CT scan was obtained to assess whether the screw directions, screw lengths, and plate position were performed according the preoperative planning. Quality of the fracture reduction was assessed by measuring residual intra-articular incongruence (maximum gap and step-off) and compared to a historical matched control group.
A total of 15 patients were treated with 3D surgical planning in which 83 screws were placed by using drilling guides. The median deviation of the achieved screw trajectory from the planned trajectory was 3.4° (interquartile range (IQR) 2.5 to 5.4) and the difference in entry points (i.e. plate position) was 3.0 mm (IQR 2.0 to 5.5) compared to the 3D preoperative planning. The length of 72 screws (86.7%) were according to the planning. Compared to the historical cohort, 3D-guided surgery showed an improved surgical reduction in terms of median gap (3.1 vs 4.7 mm; p = 0.126) and step-off (2.9 vs 4.0 mm; p = 0.026).
The use of 3D surgical planning including drilling guides was feasible, and facilitated accurate screw directions, screw lengths, and plate positioning. Moreover, the personalized approach improved fracture reduction as compared to a historical cohort.
恰当的术前规划有利于胫骨平台骨折手术中的骨折复位、固定及稳定性。我们开发并在临床上实施了一种用于三维手术规划的新型工作流程，包括在胫骨平台骨折手术中使用患者特异性钻孔导向器。
进行了一项前瞻性可行性研究，连续的胫骨平台骨折患者接受三维手术规划治疗，包括将患者特异性钻孔导向器应用于标准的现成钢板。术后获得CT扫描以评估螺钉方向、螺钉长度和钢板位置是否按照术前规划执行。通过测量残余关节内不匹配（最大间隙和台阶）评估骨折复位质量，并与历史匹配对照组进行比较。
共有15例患者接受了三维手术规划治疗，其中使用钻孔导向器置入了83枚螺钉。与术前三维规划相比，实际螺钉轨迹与规划轨迹的中位偏差为3.4°（四分位间距（IQR）2.5至5.4），进针点（即钢板位置）差异为3.0毫米（IQR 2.0至5.5）。72枚螺钉（86.7%）的长度符合规划。与历史队列相比，三维引导手术在中位间隙（3.1对4.7毫米；p = 0.126）和台阶（2.9对4.0毫米；p = 0.026）方面显示出更好的手术复位效果。
使用包括钻孔导向器的三维手术规划是可行的，有助于实现准确的螺钉方向、螺钉长度和钢板定位。此外，与历史队列相比，个性化方法改善了骨折复位效果。
