Infantile Blount's disease is a condition that causes genu varum and internal tibial torsion. Treatment options include observation, orthotics, corrective osteotomy, elevation of the medial tibial plateau, resecti...Infantile Blount's disease is a condition that causes genu varum and internal tibial torsion. Treatment options include observation, orthotics, corrective osteotomy, elevation of the medial tibial plateau, resection of a physeal bar, lateral hemi-epiphysiodesis, and guided growth of the proximal tibial physis. Each of these treatment options has its disadvantages. Treating the coronal deformity alone(genu varum) will result in persistence of the internal tibial torsion(the axial deformity). In this report, we describe the combination of lateral growth modulation and distal tibial external rotation osteotomy to correct all the elements of the disease. This has not been described before for treatment of Blount's disease. Both coronal and axial deformities were corrected in this patient. We propose this combination(rather than the lateral growth modulation alone) as the method of treatment for early stages of Blount's disease as it corrects both elements of the disease and in the same time avoids the complications of proximal tibial osteotomy.展开更多
Background： The conventional method cannot guarantee the precise osteotomies required for a perfect realignment and a better prognosis after total knee arthroplasty （TKA）.This study investigated a customized guide ...Background： The conventional method cannot guarantee the precise osteotomies required for a perfect realignment and a better prognosis after total knee arthroplasty （TKA）.This study investigated a customized guide plate for osteotomy placement in TKAs with the aid of the statistical shape model technique using weight-bearing lower-extremity X-rays and computed tomography （CT） images of the knee.Methods： From October 2014 to June 2015, 42 patients who underwent a TKA in Guizhou Provincial People＆#39;s Hospital were divided into a guide plate group （GPG, 21 cases） and a traditional surgery group （TSG, 21 cases） using a random number table method.In the GPG group, a guide plate was designed and printed using preoperative three-dimensional measurements to plan and digitally simulate the operation.TSG cases were treated with the conventional method.Outcomes were obtained from the postoperative image examination and short-term follow-up.Results： Operative time was 49.0 ＆#177; 10.5 min for GPG, and 62.0 ＆#177; 9.7 min in TSG.The coronal femoral angle, coronal tibial angle, posterior tibial slope, and the angle between the posterior condylar osteotomy surface and the surgical transepicondylar axis were 89.2 ＆#177; 1.7＆#176;, 89.0 ＆#177; 1.1＆#176;, 6.6 ＆#177; 1.4＆#176;, and 0.9 ＆#177; 0.3＆#176; in GPG, and 86.7 ＆#177; 2.9＆#176;, 87.6 ＆#177; 2.1＆#176;, 8.9 ＆#177; 2.8＆#176;, and 1.7 ＆#177; 0.8＆#176; in TSG, respectively.The Hospital for Special Surgery scores 3 months after surgery were 83.7 ＆#177; 18.4 in GPG and 71.5 ＆#177; 15.2 in TSG.Statistically significant differences were found between GPG and TSG in all measurements.Conclusions： A customized guide plate to create an accurate osteotomy in TKAs may be created using lower-extremity X-ray and knee CT images.This allows for shorter operative times and better postoperative alignment than the traditional surgery.Application of the digital guide plate may also result in better short-term outcomes.展开更多
目的设计制造一种考虑假体尺寸的全膝关节置换术截骨导板(简称截骨导板),实现术中快速、精准定位、辅助截骨的目的。方法截骨导板采用德国EOS公司的FORMIGA P 110三维(3D)打印设备制造,打印材料为聚十二内酰胺(PA12)。通过CT、股骨3D重...目的设计制造一种考虑假体尺寸的全膝关节置换术截骨导板(简称截骨导板),实现术中快速、精准定位、辅助截骨的目的。方法截骨导板采用德国EOS公司的FORMIGA P 110三维(3D)打印设备制造,打印材料为聚十二内酰胺(PA12)。通过CT、股骨3D重建、假体逆向重建获得股骨远端与假体的数字模型,用计算机手术预演确定合理尺寸的假体,固定股骨远端与假体的接触面作为截骨平面,以该平面为基准逐步装配其他部件。3D打印设备模型输入格式为病理性股骨标准模板库(STL),采用选择性激光烧结(SLS)技术生产截骨导板,打印主体材料为聚十二内酰胺(PA12)。制造成品灭菌消毒后,于2019年至2021年用于3例因严重骨关节炎实施的截骨手术,其中男性2例,女性1例;患处位于左侧1例,右侧2例;年龄54~67岁,平均年龄59岁。术中医生严格按照截骨导板使用指南实施截骨手术。统计术中和术后失血量、手术时间、髋膝踝角、胫股角、美国膝关节协会评分(AKS)与美国特种外科医院(HSS)膝关节功能评分对手术结果进行评估。结果成功打印制造截骨导板,主要尺寸:固定钉钉孔到截骨平面的垂直距离10.17~12.51 mm,前髁固定钉钉孔直径3.18 mm;截骨槽宽度1.42 mm,固定钉中心点距离45.44 mm,固定钉钉孔直径3.16 mm。临床试用表明,在截骨手术中使用截骨导板定位股骨远端面,切面呈规则“8”字形状,无明显过切或少切现象,能保证截骨的准确性。未发生摆锯与截骨导板干涉或截骨导板破裂等需要中断手术的事件。术后患者膝关节功能恢复良好,随访过程中未出现假体松动、下沉、膝内外翻畸形、移位、股骨端骨折、脂肪栓塞等不良反应。结论实验研究设计制造的截骨导板能够准确定位,相较于普通截骨工具具有无需开髓、一次安装、多次定位的功能。基于3D打印技术的手术预演有利于医生术前根据患者骨形确定假体规格,提前熟悉截骨参数,预估手术难度,考虑术中可能出现的各种问题,从而制订适合患者的个体化、最优化手术方案。展开更多
文摘Infantile Blount's disease is a condition that causes genu varum and internal tibial torsion. Treatment options include observation, orthotics, corrective osteotomy, elevation of the medial tibial plateau, resection of a physeal bar, lateral hemi-epiphysiodesis, and guided growth of the proximal tibial physis. Each of these treatment options has its disadvantages. Treating the coronal deformity alone(genu varum) will result in persistence of the internal tibial torsion(the axial deformity). In this report, we describe the combination of lateral growth modulation and distal tibial external rotation osteotomy to correct all the elements of the disease. This has not been described before for treatment of Blount's disease. Both coronal and axial deformities were corrected in this patient. We propose this combination(rather than the lateral growth modulation alone) as the method of treatment for early stages of Blount's disease as it corrects both elements of the disease and in the same time avoids the complications of proximal tibial osteotomy.
文摘Background： The conventional method cannot guarantee the precise osteotomies required for a perfect realignment and a better prognosis after total knee arthroplasty （TKA）.This study investigated a customized guide plate for osteotomy placement in TKAs with the aid of the statistical shape model technique using weight-bearing lower-extremity X-rays and computed tomography （CT） images of the knee.Methods： From October 2014 to June 2015, 42 patients who underwent a TKA in Guizhou Provincial People＆#39;s Hospital were divided into a guide plate group （GPG, 21 cases） and a traditional surgery group （TSG, 21 cases） using a random number table method.In the GPG group, a guide plate was designed and printed using preoperative three-dimensional measurements to plan and digitally simulate the operation.TSG cases were treated with the conventional method.Outcomes were obtained from the postoperative image examination and short-term follow-up.Results： Operative time was 49.0 ＆#177; 10.5 min for GPG, and 62.0 ＆#177; 9.7 min in TSG.The coronal femoral angle, coronal tibial angle, posterior tibial slope, and the angle between the posterior condylar osteotomy surface and the surgical transepicondylar axis were 89.2 ＆#177; 1.7＆#176;, 89.0 ＆#177; 1.1＆#176;, 6.6 ＆#177; 1.4＆#176;, and 0.9 ＆#177; 0.3＆#176; in GPG, and 86.7 ＆#177; 2.9＆#176;, 87.6 ＆#177; 2.1＆#176;, 8.9 ＆#177; 2.8＆#176;, and 1.7 ＆#177; 0.8＆#176; in TSG, respectively.The Hospital for Special Surgery scores 3 months after surgery were 83.7 ＆#177; 18.4 in GPG and 71.5 ＆#177; 15.2 in TSG.Statistically significant differences were found between GPG and TSG in all measurements.Conclusions： A customized guide plate to create an accurate osteotomy in TKAs may be created using lower-extremity X-ray and knee CT images.This allows for shorter operative times and better postoperative alignment than the traditional surgery.Application of the digital guide plate may also result in better short-term outcomes.
