计算机导航模板在儿童膝内外翻的初步应用

The Preliminary Application of the Computer Navigation Template in Children’s Genu Varus and Genu Valgum

目的:观察计算机导航模板在膝内外翻畸形矫正中的初步应用。方法:对2013年4月至2016年4月收治的12例膝内外翻畸形患儿进行膝关节连续螺旋CT扫描,将原始Dicom格式数据导入Mimics15.0软件,三维重建膝关节模型,以.stl格式保存,导入Imageware10.0软件,根据畸形情况设计最佳钢板放置位置。提取股骨的表面解剖学形态,建立与股骨远端矫正范围解剖学形态一致的模板,将模板通过激光快速成形技术生产出实物模板,手术时将建立的矫正导航模板与股骨远端矫正部相吻合,沿矫正导航模板进行矫正后8字钢板固定。术后根据X线片评价临床疗效。结果:12例患儿所有8字钢板均准确植入,无一例骨骺损伤,患儿创口无感染及深部血管神经损伤,伤口愈合良好。随访12~24个月,12例患儿中有11例畸形完全矫正,有1例残留有股骨弓形畸形(术前有佝偻病),全部病例未出现螺钉断裂、双下肢不等长、骨骺早闭等并发症。结论:采用计算机三维重建技术设计的矫正导航模板可以为儿童膝内外翻畸形矫正术提供一种新的方法,具有较大的应用前景。

Objective:To observe the application of digital template as navigation for treatment of genu varus or valgum in children.Method:Between April 2013 and April 2016,the computer simulation technique was applied to 12 patients with genu varus or valgum,All patients underwent CT scan for the three-dimensionaI reconstruction.The 3 D reconstruction models for the desired femurs were generated by using the Mimics 15.0 software.The 3 D models of femurs were imported into Imageware 10.0 software.A virtual navigational template was established according to femoral anatomic trait.Results:All the incisions healed at the same time without any incision infection.All the screws are accurately implanted without intraoperative and postoperative complications.Accurate screw placement was confirmed with postoperative X-ray.All cases were followed from 12 to 24 months.Conclusions:A novel method of osteotomy navigational template using digitized 3-dimensional reconstruction techniques has been developed,the patient-specific template is found to be highly accuracy and has great expectation.