Assink Nick, Binnekamp Cornelia W, van der Veen Hugo C, Doornberg Job N, IJpma Frank F A, Pijpker Peter A J
Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands.
3D Lab, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands.
J Clin Med. 2024 Oct 17;13(20):6175. doi: 10.3390/jcm13206175.
: 3D patient-specific corrective osteotomies are optimized for use with oscillating saws, thereby rendering it incapable of executing curved osteotomies. The aim of this technical note is to introduce and evaluate the Panflute technique, which facilitates curved osteotomies with precise depth control for intra-articular corrective osteotomies in posttraumatic tibial plateau malunions. : A 33-year-old male patient with an intra-articular malunion was treated one year after index surgery of a lateral split-depression tibial plateau fracture with the Panflute technique. The guide design allowed for multiple drill trajectories in a curved path, recreating the original fracture lines. Cylindrical drill tubes in the guide were tailored to match bone trajectory length. This resulted in a patient-specific Panflute-like design enabling precise depth control, safeguarding posterior neurovascular structures. Secondly, the recreated fragment was reduced with a reduction guide, applied to the plate in situ, to facilitate reposition using the plate as tool and reference. : The procedure went without technical drawbacks or surgical complications. Postoperative assessment showed that repositioning of the osteotomized articular fragment was performed accurately: pre- to postoperative translational corrections were 5.4 to 0.5 mm posterior displacement for AP deformity (-axis); 2.9 to 1.0 mm lateral to medial reduction (-axis); and 5.9 to 0.6 mm cranial-caudal correction (-axis). Clinically, at 3 months, the fracture united, the patient regained full flexion, and valgus defect-laxity resolved. : The presented Panflute-osteotomy guide allows for a pre-planned curved osteotomy. Additionally, for every drill trajectory, the depth could be controlled. The proposed method may expand our surgical armamentarium of patient-specific 3D techniques and solutions for complex intra-articular osteotomies.
3D 个性化矫正截骨术针对摆动锯进行了优化，因此无法执行弯曲截骨术。本技术说明的目的是介绍和评估 Panflute 技术，该技术有助于在创伤后胫骨平台畸形愈合的关节内矫正截骨术中进行精确深度控制的弯曲截骨术。：一名 33 岁的男性关节内畸形愈合患者在接受外侧劈裂凹陷型胫骨平台骨折初次手术后一年，采用 Panflute 技术进行治疗。导向设计允许在弯曲路径上进行多条钻孔轨迹，重现原始骨折线。导向器中的圆柱形钻管经过定制，以匹配骨轨迹长度。这产生了一种个性化的类似 Panflute 的设计，能够实现精确深度控制，保护后神经血管结构。其次，使用复位导向器将重新创建的骨块复位，原位应用于钢板，以便将钢板用作工具和参考来促进重新定位。：该手术没有技术缺陷或手术并发症。术后评估表明，截骨后的关节骨块重新定位准确：术前至术后前后移位矫正为 AP 畸形（-轴）后移 5.4 至 0.5 毫米；内外侧复位（-轴）为 2.9 至 1.0 毫米；头尾向矫正（-轴）为 5.9 至 0.6 毫米。临床上，3 个月时骨折愈合，患者恢复了完全屈曲，外翻缺陷松弛得到解决。：所展示的 Panflute 截骨导向器允许进行预先计划的弯曲截骨术。此外，对于每条钻孔轨迹，都可以控制深度。所提出的方法可能会扩展我们针对复杂关节内截骨术的个性化 3D 技术和解决方案的手术器械库。
