Leluc Julien, Mabrouk Ahmed, Hirth Jacob, Nawabi Danyal, Jacquet Christophe, Ollivier Matthieu
Department of Trauma and Orthopaedics, Institute for Locomotion, Sainte-Marguerite Hospital Aix-Marseille University Marseille France.
Department of Trauma and Orthopaedics Basingstoke and North Hampshire Hospital Basingstoke UK.
J Exp Orthop. 2024 Dec 30;12(1):e70131. doi: 10.1002/jeo2.70131. eCollection 2025 Jan.
Asymmetric anterior closing-wedge high tibial osteotomy (ACWHTO) allows correction of both excessive posterior tibial slope (PTS) and varus deformity. However, the complexity of this surgery requires a high degree of accuracy, which is less likely to be achieved with standard instrumentations. This study aimed to determine the accuracy of 3D patient-specific cutting guides (PSCGs) to provide the accurate planned correction in the frontal and sagittal planes.
Eight sawbones tibiae were identically printed from the same patient data. An ACWHTO with a PSCG was performed on each sawbone. Postoperative measurements of PTS, mechanical medial proximal tibial angle (mMPTA), hinge area and hinge-posterior cruciate ligament (hinge-PCL) distance were compared with the preoperative planned measurements. The precision was defined as the absolute difference (∆) between the target planned values and postoperative values.
The mean accuracy was 0.6° ± 0.74° for PTS, 0.8° ± 0.71° for mMPTA, 0.3 ± 0.2 cm for hinge area and 0.1 ± 0.06 mm for hinge-PCL distance.
In the setting of sawbones, the use of PSCGs was a reliable and accurate method of achieving simultaneous correction in the frontal and sagittal planes during asymmetric ACWHTO.
Level V, basic science biomechanical laboratory study.
不对称前侧闭合楔形高位胫骨截骨术（ACWHTO）可同时矫正胫骨后倾坡度（PTS）过大和内翻畸形。然而，该手术的复杂性要求高度精确，而标准器械不太可能达到这一要求。本研究旨在确定三维个体化截骨导板（PSCGs）在额状面和矢状面提供精确计划矫正的准确性。
从同一患者数据中相同打印出八具胫骨模型。在每个模型上使用PSCG进行ACWHTO手术。将术后测量的PTS、胫骨近端内侧机械角（mMPTA）、铰链区和铰链-后交叉韧带（铰链-PCL）距离与术前计划测量值进行比较。精确度定义为目标计划值与术后值之间的绝对差值（∆）。
PTS的平均准确度为0.6°±0.74°，mMPTA为0.8°±0.71°，铰链区为0.3±0.2 cm，铰链-PCL距离为0.1±0.06 mm。
在胫骨模型的情况下，使用PSCGs是在不对称ACWHTO期间在额状面和矢状面实现同时矫正的可靠且准确方法。
V级，基础科学生物力学实验室研究。
