Márquez-Gómez Miguel, Castaño-Zapatero Carlos Manuel, Mediavilla-Santos Lydia, Pérez-Mañanes Rubén, Vaquero-Martín Javier
Department of Orthopaedic and Trauma Surgery, Hospital General Universitario Gregorio Marañon, C. Dr. Esquerdo 46, 28007, Madrid, Spain.
J Orthop Case Rep. 2024 Dec;14(12):78-82. doi: 10.13107/jocr.2024.v14.i12.5026.
Extra-articular deformity is that located proximal to the femoral epicondyles or distal to the neck of the fibula. In patients with gonarthrosis associated with extra-articular deformity, a different evaluation and approach will be necessary at the time of planning the arthroplasty. 3D planning and printing techniques have had a major impact on pre-operative planning, allowing the production of custom guides at low cost and in an accessible way. To our knowledge, this is the first report of combined 3D-guided extra-articular femoral osteotomy and total knee arthroplasty (TKA) for the treatment of extra-articular deformity and knee osteoarthritis.
We present the case of a 48-year-old caucasian male with gonarthrosis and a history of supracondylar femoral fracture with vicious consolidation. The pre-operative scan images were used for planning in collaboration with the engineers of the 3D planning and printing unit of our hospital. Two guides were designed and printed using biocompatible resin. The first one has a cannulated cylinder attached to a template of the patient's distal femoral surface to locate the entry point to the intramedullary canal. The second one fits the anterior cortex of the femur, over the fracture callus, and has six cannulated cylinders attached; four of them guided K-wires through the plane of the osteotomy and the other two guided position K-wires that would ensure canal alignment in the next step. A fixation and control plate was designed to maintain the corrected alignment until the definitive fixation with a retrograde femoral nail. After corrective osteotomy and fixation, TKA was performed. Six months after surgery, the patient is independent, pain-free, and does not use mechanical aids for walking. X-ray shows consolidation of the osteotomy and restoration of the mechanical axis of the limb.
The use of home 3D printers and open-source software, as well as the creation of a multidisciplinary 3D unit with orthopedic surgeons and bioengineers, makes it possible to obtain customized guides or implants with satisfactory clinical results at minimal cost.
关节外畸形是指位于股骨髁上近端或腓骨颈远端的畸形。在患有与关节外畸形相关的膝关节病的患者中，在规划关节置换术时需要进行不同的评估和采取不同的方法。三维规划和打印技术对术前规划产生了重大影响，能够以低成本且便捷的方式制作定制导板。据我们所知，这是首例关于采用三维引导下关节外股骨截骨术与全膝关节置换术（TKA）联合治疗关节外畸形和膝关节骨关节炎的报告。
我们报告一例48岁白种男性患者，患有膝关节病，有股骨髁上骨折不愈合病史。术前扫描图像与我院三维规划和打印部门的工程师合作用于规划。使用生物相容性树脂设计并打印了两个导板。第一个导板有一个空心圆柱体连接到患者股骨远端表面的模板上，用于确定髓内通道的入口点。第二个导板贴合股骨前皮质，位于骨折骨痂上方，有六个空心圆柱体连接；其中四个引导克氏针穿过截骨平面，另外两个引导定位克氏针，以确保下一步髓内通道对齐。设计了一个固定和控制板，以维持矫正后的对线，直至用逆行股骨钉进行最终固定。在进行矫正截骨和固定后，实施了全膝关节置换术。术后六个月，患者能够独立活动，无痛，行走无需辅助器械。X线显示截骨处愈合，肢体机械轴恢复。
使用家用三维打印机和开源软件，以及创建由骨科医生和生物工程师组成的多学科三维团队，使得能够以最低成本获得定制导板或植入物，并取得令人满意的临床效果。
