个性化术前规划结合不同固定方式治疗下肢多平面畸形的应用

Individualized preoperative planning combined with various fixations for treatment of multiplanar deformities at lower extremity

目的探讨个性化术前规划结合不同固定方式治疗下肢复杂多平面畸形的应用效果。方法回顾性分析2018年1月到2019年5月哈尔滨医科大学附属第一医院收治4例下肢复杂多平面畸形的患者资料。男1例,女3例;年龄12~65岁,平均28.8岁。所有患者术前行薄层(1 mm)CT扫描,通过CT数据进行个性化术前规划和模拟,并用3D打印技术制作手术导板,为术中提供截骨导向。记录患者手术时间、术中透视次数、骨折愈合时间、患者手术前后Lysholm评分、美国特种外科医院(HSS)膝关节功能评分、疼痛视觉模拟评分(VAS)及术后并发症情况等。结果手术时间平均160.0 min。术中透视次数平均5.0次。所有患者术后获平均8.8个月随访。骨折愈合时间平均6.3个月。术前、术后Lysholm评分平均分别为55.8、80.5分,术前、术后HSS评分平均分别为61.0、80.8分,术前、术后VAS评分平均分别为3.8、1.0分。术中依据手术导板做到了精准截骨,导板在应用过程中未出现变形、断裂等问题。随访期间所有患者下肢全长X线片显示力线良好,无畸形复发,未发生感染、内固定物断裂、截骨延期愈合或不愈合等并发症。结论对于下肢多平面畸形的患者,术前进行个性化手术规划,可以准确计算出截骨的相关参数,并借助3D打印的截骨导板结合不同的内固定方式,做到精准矫形,术后获得良好的疗效,保证了手术的安全性、精准性和高效性。

Objective To evaluate the efficacy of individualized preoperative planning combined with various fixations in the treatment of complex multiplanar deformities at lower extremity.Methods Four patients with complex multiplanar deformities at lower extremity were treated at Department of Orthopedics,The First Affiliated Hospital to Harbin Medical University from January 2018 to May 2019.They were one male and 3 females,aged from 12 to 65 years(average,28.8 years).All patients underwent thin-layer(1 mm)CT scan before surgery.Individualized preoperative planning and surgical simulation were conducted using the CT data.3D printing technology was used to fabricate individualized surgical templates to facilitate osteotomy.Recorded were operation time,frequency of intraoperative fluoroscopy,fracture healing time,Lysholm scores before and after operation,Hospital for Special Surgery(HSS)knee function scores,pain scores of visual analogue scale(VAS)and postoperative complications in this cohort.Results The operation time averaged 160.0 min,the frequency of intraoperative fluoroscopy 5.0 times,the follow-up duration for the 4 patients 8.8 months,the fracture healing time 6.3 months,the Lysholm scores before and after operation 55.8 and 80.5 points respectively,the HSS scores before and after operation 61.0 and 80.8 points respectively,and the VAS scores before and after operation 3.8 and 1.0 points respectively.Accurate osteotomy was achieved with assistance of the templates and no deformation or breakage of the templates was observed.Follow-ups showed fine alignment of the lower extremities by the full-length X-ray films and no recurrence of deformity,infection,implant breakage,or delayed union or non-union of the osteotomy sites.Conclusions For patients with multiplanar deformities at lower extremity,individualized preoperative planning can be made before surgery to obtain the accurate parameters relevant to the osteotomy.In combination with various fixations,a patient-specific template made by 3D printing can be used to achieve accurate osteotomy,ensuring good efficacy,safety,efficiency and accuracy of the surgery.