Wagner Grayson A, Glennon Alyssa, Sieberer Johannes M, Tommasini Steven M, Lattanza Lisa L
Yale University School of Engineering & Applied Science, New Haven, CT.
Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT.
J Hand Surg Glob Online. 2024 Dec 13;7(2):158-166. doi: 10.1016/j.jhsg.2024.11.008. eCollection 2025 Mar.
This study proposes a patient-specific three-dimensional (3D)-printed surgical guide designed for scaphoid fracture fixation through a limited dorsal approach.
Computed tomography scans of five cadaveric wrists were modeled in 3D segmentation software and cannulated screw guidewire trajectory was planned. Custom 3D-printed surgical guides for guidewire insertion were designed for each scaphoid. Guidewire placement was performed with and without the surgical guide through a dorsal approach. Postoperative scans were overlaid with the planned trajectory and compared. Five variables were measured: angular deviation, distance between entry points, distance between exit points, embedded guidewire length, and number of attempts.
Mean angular deviation from the planned trajectory was 10.80 ± 6.72° for the guided and 14.08 ± 4.65° for the freehand group. The offset between entry and exit for the guided group was 2.22 ± 1.04 and 3.52 ± 2.80 mm and for the freehand group 2.95 ± 1.31 and 4.91 ± 2.37 mm, respectively. The mean length for the guided group was 23.25 ± 3.33 mm and 23.31 ± 3.07 mm for the freehand group. All guided cases took one attempt and the freehanded cases 2.0 ± 1.0 attempts. A significant positive correlation was found between trajectory and exit. No significance between groups was found between any of the measured variables. A minimum sample size of 28 was determined for follow-up studies.
The use of a custom surgical guide improved guidewire placement in four of five specimens when compared with a freehand approach. Specifically, the trajectory was closer to the planned trajectory. All guidewire placements were clinically acceptable. Therefore, we consider the use of this surgical guide for the dorsal approach feasible to be used in clinical practice.
This device could be used to treat nondisplaced scaphoid fractures. The use of a custom surgical guide could allow for accurate and efficient screw placement as well as reduced operating time and fluoroscopy exposure.
本研究提出一种针对舟骨骨折经有限背侧入路固定设计的患者特异性三维（3D）打印手术导板。
对五具尸体手腕进行计算机断层扫描，在3D分割软件中建模，并规划空心螺钉导丝轨迹。为每块舟骨设计定制的用于导丝插入的3D打印手术导板。通过背侧入路，分别在使用和不使用手术导板的情况下进行导丝置入。术后扫描图像与规划轨迹叠加并进行比较。测量五个变量：角度偏差、进针点间距、出针点间距、导丝置入长度和尝试次数。
使用手术导板组与徒手操作组相比，平均角度偏差分别为10.80±6.72°和14.08±4.65°。使用手术导板组进针点与出针点之间的偏移分别为2.22±1.04和3.52±2.80mm，徒手操作组分别为2.95±1.31和4.91±2.37mm。使用手术导板组的平均长度为23.25±3.33mm，徒手操作组为23.31±3.07mm。所有使用手术导板的病例均一次成功，徒手操作组平均2.0±1.0次成功。发现轨迹与出针点之间存在显著正相关。在任何测量变量之间，两组之间均未发现显著差异。确定随访研究的最小样本量为28例。
与徒手操作相比，使用定制手术导板在五个标本中的四个改善了导丝置入。具体而言，轨迹更接近规划轨迹。所有导丝置入在临床上均可接受。因此，我们认为这种用于背侧入路的手术导板在临床实践中使用是可行的。
该装置可用于治疗无移位的舟骨骨折。使用定制手术导板可实现准确、高效的螺钉置入，同时减少手术时间和透视暴露。
