个体化数字导航模板辅助儿童肘内翻畸形精准截骨

Accurate osteotomy assisted by individualized navigation templates for the treatment of children cubitus varus

目的 :探讨利用计算机辅助设计和3D打印技术制作的一种个体化手术导航模板实现儿童肘内翻畸形精准截骨的可行性。方法:2015年6月至2016年6月需手术治疗的15例儿童肘内翻畸形患者,依据上肢CT数据结合计算机软件设计并利用3D打印机打印出与肱骨远端匹配的截骨导航模板。术中在导航模板辅助下精准截骨,纠正冠状面的内翻畸形和水平面的内旋畸形,2枚克氏针交叉固定截骨断端,伸直位石膏固定,术后定期复查X线片。结果:计算机辅助设计和3D打印的个体化手术导航模板术中与肱骨远端骨性标志匹配良好,沿导航模板截骨面进行截骨精准简便,术后患肢外观满意,截骨端平均愈合时间6.7周(6~8周)。随访3~6个月后影像学和肘关节活动范围评估优12例,良3例,无切口感染、内固定松动断裂或继发性尺神经炎发生。结论:3D打印个体化手术导航模板可以辅助儿童肘内翻畸形的精准截骨,最大程度恢复肘关节正常解剖结构,操作方便,值得推广应用。

Objective：To investigate the feasibility and accuracy of a new navigation template for osteotomy in cubitus varus based on computer assistant design and 3D printing technology.Methods：The preoperative CT images of 15 children with cubitus varus from June 2015 to June 2016 were collected.According to the above data,the individual osteotomy navigate template match the distal humerus was designed by the software and printed by the 3D printer.Accurate osteotomy was performed with the assistant of the navigate template in the operation.Internal fixation of the osteotomy site was performed with 2Kirschner wires.After surgery,a long arm plaster was applied with 20° of elbow flexion.All the patients underwent radiograph-ic and clinical evaluations before surgery and at the follow-up examination.Results：During the operation,the navigate template with the individual design of 3D printing technology matched the bony markers of distal humerus.Accurate and simple osteotomy were performed along the resected surface of the navigation template.None of the cases required any kinds of revision surgery or had any complaint of cosmetic appearance.Average union time was 6.7 weeks（ranged,6 to 8 weeks）.Twelve patients got an excellent result and 2 got a good result according to the criteria described by Bellemore.There were no cases with complications of infection or ulnar nerve palsy or joint stiffness.Conclusion：With the help of 3D printing technology,the accurate osteotomy in cubitus varus assisted by individualized navigate template can be realized.This technology can restore normal anatomical structure of the elbow joint to the greatest extent.It is worthy of popularization and application.