Oldhoff M G E, Alvarez C Posada, Ten Duis K, Doornberg J N, Assink N, IJpma F F A
Department of Trauma Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
3D Lab, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
Eur J Trauma Emerg Surg. 2025 Jan 24;51(1):53. doi: 10.1007/s00068-024-02755-w.
The aim of this study was to evaluate the feasibility of using patient-specific implants (PSI) for complex shaft corrective osteotomies in multiplanar deformities of long bones in the lower extremities. Additionally, it aimed to investigate the added value of these implants by quantifying surgical accuracy on postoperative CT, comparing their outcomes to two commonly used techniques: 3D virtual visualizations and 3D-printed surgical guides.
Six tibial and femoral shaft corrective osteotomies were planned and performed on three Thiel embalmed human specimen. Depending on the specimen a different respective technique was used; 1) '3D Visualization' using 3D virtual plan preoperatively and free-hand corrective osteotomy techniques with standard manually contoured plates; 2) '3D guided' utilizing 3D surgical guides and manually contouring of conventional implant; and 3)'3D PSI' utilizing a 3D surgical guide with a patient-specific implant. Accuracy of the corrections was assessed through measurements for varus/valgus angulation, ante/recurvation, rotation and osteotomy plane error as quantified on postoperative CT-scans.
Twelve corrective osteotomies were performed. For, the median difference between the surgical plan and postoperative CT assessment was 3.4°, 4.6°, and 2.2° for the '3D visualization', '3D guided', and '3D PSI' methods respectively. Regarding ante/recurvation, the differences were 3.8°, 43.8°, and 1.2°, respectively. For rotation, the differences were 11.9°, 18.7°, and 3.5°, respectively. Discrepancies between planned and executed levels of osteotomy plane were 6.2 mm, 3.2 mm, and 1.4 mm, respectively.
PSIs with 3D-printed drilling guides for complex multiplanar corrective osteotomies of femoral and tibial shaft malunions is feasible and achieves accurate corrections. This technique enables precise determination of the osteotomy plane, guides correction in all three planes, and ensures satisfactory implant fitting; thus accurately translating the virtual surgical plan into clinical practice. The 3D PSI method is beneficial for complex cases with significant multiplanar deformities in bone anatomy, particularly with rotational malalignment.
本研究旨在评估使用定制植入物（PSI）对下肢长骨多平面畸形进行复杂骨干矫正截骨术的可行性。此外，通过对术后CT上的手术精度进行量化，将这些植入物的效果与两种常用技术（3D虚拟可视化和3D打印手术导板）进行比较，以研究这些植入物的附加价值。
在三个经蒂尔固定的人体标本上计划并实施了六例胫骨干和股骨干矫正截骨术。根据标本的不同采用了不同的技术；1）“3D可视化”，术前使用3D虚拟计划并采用标准手动塑形钢板的徒手矫正截骨技术；2）“3D引导”，利用3D手术导板并对传统植入物进行手动塑形；3）“3D PSI”，利用带有定制植入物的3D手术导板。通过术后CT扫描量化的内翻/外翻成角、前/后弯、旋转和截骨平面误差测量来评估矫正的准确性。
共进行了12例矫正截骨术。对于“3D可视化”“3D引导”和“3D PSI”方法，手术计划与术后CT评估之间的中位数差异分别为3.4°、4.6°和2.2°。关于前/后弯，差异分别为3.8°、43.8°和1.2°。对于旋转，差异分别为11.9°、18.7°和3.5°。计划截骨平面与实际执行截骨平面之间的差异分别为6.2mm、3.2mm和1.4mm。
带有3D打印钻孔导板的PSI用于股骨干和胫骨干畸形愈合的复杂多平面矫正截骨术是可行的，并且能够实现精确矫正。该技术能够精确确定截骨平面，在所有三个平面上引导矫正，并确保植入物贴合良好；从而将虚拟手术计划准确转化为临床实践。3D PSI方法对于骨解剖结构存在明显多平面畸形，尤其是存在旋转畸形的复杂病例有益。
