Carey E Grant, Kamath Atul F, Vidal Armando F, Frush Todd, Alaia Michael, Baldwin Robert B, Ranawat Anil
OrthoCarolina, Charlotte, North Carolina, USA.
The Hospital for Special Surgery, New York, New York, USA.
Orthop J Sports Med. 2025 Jan 28;13(1):23259671241285430. doi: 10.1177/23259671241285430. eCollection 2025 Jan.
Traditional freehand techniques in high tibial osteotomy (HTO) have been shown to lack precision and accuracy. Patient-specific instrumentation (PSI) and fixation created from cross-sectional imaging have recently been introduced to address this problem.
PURPOSE/HYPOTHESIS: The purpose of the study was to compare traditional freehand techniques versus PSI in a human cadaveric model of HTO. It was hypothesized that the osteotomies performed using PSI would require less radiation exposure for operating room staff and would reduce deviation from the planned correction in the coronal, sagittal, and axial planes.
Controlled laboratory study.
Sixteen matched cadaveric knees underwent medial opening-wedge HTO via the freehand method (n = 8) or PSI technique (n = 8) with a predetermined planned opening-wedge size. Computed tomography was used to measure the achieved wedge size as well as alignment parameters in the coronal, sagittal, and axial planes. Radiation dose, number of fluoroscopic images taken, and total operative time were recorded.
The mean deviation from the planned wedge size was smaller in the PSI group compared with the freehand group (0.505 vs 3.016 mm, respectively; < .01). Total radiation dose to medical staff (0.85 vs 2.04 mGy; < .01) and number of fluoroscopic images (15.5 vs 41; < .01) were also smaller in the PSI versus the freehand group, respectively. No difference was seen in total operative time between the 2 groups ( = .62).
In cadaveric specimens, the PSI technique demonstrated superior accuracy and decreased radiation exposure for medical staff compared with the traditional freehand technique without compromising operative efficiency.
The use of PSI when HTO is performed can lead to more accurate operations and potentially improve outcomes.
已有研究表明，传统的胫骨高位截骨术（HTO）徒手技术缺乏精确性和准确性。最近引入了基于横断面成像创建的患者特异性器械（PSI）及固定方法来解决这一问题。
目的/假设：本研究的目的是在HTO人体尸体模型中比较传统徒手技术与PSI。研究假设为，使用PSI进行的截骨术对手术室工作人员的辐射暴露更少，并且会减少在冠状面、矢状面和轴位面上与计划矫正的偏差。
对照实验室研究。
16对匹配的尸体膝关节通过徒手方法（n = 8）或PSI技术（n = 8）进行内侧开口楔形HTO，采用预定的计划开口楔形尺寸。使用计算机断层扫描测量获得的楔形尺寸以及冠状面、矢状面和轴位面上的对线参数。记录辐射剂量、透视图像数量和总手术时间。
与徒手组相比，PSI组与计划楔形尺寸的平均偏差更小（分别为0.505 vs 3.016 mm；P <.01）。PSI组与徒手组相比，医护人员的总辐射剂量（0.85 vs 2.04 mGy；P <.01）和透视图像数量（15.5 vs 41；P <.01）也分别更小。两组之间的总手术时间没有差异（P =.62）。
在尸体标本中，与传统徒手技术相比，PSI技术显示出更高的准确性，并且减少了医护人员的辐射暴露，同时不影响手术效率。
进行HTO时使用PSI可使手术更精确，并可能改善手术效果。
