3D打印导航模板在儿童后天性肘内翻畸形矫形手术中的应用

Application of 3D printed navigation template in correction of acquired c ubitus varus deformity in children

目的:探讨3D打印导航模板在儿童后天性肘内翻畸形矫形手术中的应用。方法:选取2012年7月至2021年7月在无锡市儿童医院接受治疗的11例肘内翻畸形患儿,其中9例男孩、2例女孩;7例左侧畸形、4例右侧畸形;年龄5~12岁(平均7.9岁)。所有患儿均采用3D打印导航模板辅助下肱骨远端外侧楔形截骨术治疗。所有患儿在手术前都进行了计算机断层扫描,使用计算机软件模拟手术截骨,设计并打印导航模板,术中使用个性化导航模板辅助施行截骨术并采用3枚克氏针固定。记录所有病例的手术时间、手术前后的搬运角度术后肘关节功能评估采用Bellemore标准。结果:所有导航模板均与相应的解剖结构匹配良好,符合术前规划。从暴露出骨质至截骨面固定牢靠耗时9~25min(平均16min),术后患肢提携角纠正为3°至15°,平均矫正27°,术后6~12个月的随访显示患肢肘关节活动度最大伸直角度为-10°~12°〔平均(2±0.4)°〕,最大屈曲角度为118°~134°〔平均(130.7±2.2)°〕,肘关节功能10例优,1例良,未见相关并发症。结论:个性化导航模板简化了操作程序,减少了操作时间,提高了肘内翻截骨矫形术的精准性。

Objective:To investigate the application of 3D printed navigation template in the correction of acquired cubitus varus deformity in children.Methods:Eleven patients with cubitus varus deformity treated in Wuxi Children’s Hospital from July 2012 to July 2021 were selected,including 9 boys and 2 girls.There were 7 cases of left deformity and 4 cases of right deformity.The age ranged from 5 to 12 years(mean,7.9 years).All patients were treated with 3D-printed navigation template assisted lateral wedge osteotomy of the distal humerus.All patients underwent computed tomography before operation.Computer software was used to simulate surgical osteotomy,and the navigation template was designed and printed.The personalized navigation template was used to assist the operation of osteotomy and fixed with 3 Kirschner wires.The operation time,handling Angle before and after operation were recorded in all cases.The postoperative elbow function was evaluated using Bellemore criteria.Results:All the navigation templates matched well with the corresponding anatomical structure,which was in line with the preoperative planning.It took 9 to 25 minutes(mean,16 minutes)to fix the osteotomy surface.The carrying Angle of the affected limb was corrected from 3°to 15°(mean,27°)after operation.The maximum extension Angle of the elbow joint range of motion of the affected limb was-10°to 12°[mean,(2±0.4)°]after 6-12 months of follow-up.The maximum flexion Angle ranged from 118°to 134°[mean(130.7±2.2)°].The elbow joint function was excellent in 10 cases and good in 1 case.Conclusion:The personalized navigation template simplifies the operation procedure,reduces the operation time,and improves the accuracy of cubitus varus osteotomy.