Ning Jinbo,Yao Mingmu.Application of three-dimensional printing technology during corrective osteotomy for cubitus varus deformity in children[J].Journal of Clinical Pediatric Surgery,2021,20(10):941-945.[doi:10.12260/lcxewkzz.2021.10.009]
3D打印技术在小儿后天性肘内翻畸形截骨矫形术中的应用
- Title:
- Application of three-dimensional printing technology during corrective osteotomy for cubitus varus deformity in children
- Keywords:
- 3D Printing; Elbow Joint/IN; Elbow Joint/AB; Cubitus Vars; Osteotomy; Surgical Procedures; Operative; Child
- 分类号:
- R726.873.1;R726.8;R682
- 摘要:
- 目的 探讨3D打印技术在小儿后天性肘内翻畸形截骨矫形术中的临床应用价值。方法 收集2016年6月至2018年8月由重庆大学附属三峡医院小儿外科收治的16例肘内翻畸形患者作为研究对象，均行截骨矫形手术治疗。其中男童10例，女童6例，平均年龄7.7岁。术前根据HSS（Hospital for Special Surgery）肘关节评分标准评价肘关节功能，行肘关节CT扫描，建立数字模型，按照1：1等比例打印3D实体模型，在模型上设计截骨平面，术中参照3D模型实施截骨矫形。手术后6个月复查，采用HSS肘关节评分标准评价肘关节功能，拍摄肘关节正侧位X线片测量肘关节提携角、肱骨前倾角和鲍曼角，并与术前设计进行比较，评价矫形效果是否符合预期。结果 16例患者均在全麻下顺利完成手术，术后均获随访，所有患者获骨性愈合，肘内翻畸形获得矫正，无神经血管损伤、术区感染、克氏针移位等并发症发生。3D模型模拟手术效果：提携角范围为9°~19°，平均（13.57±2.62）°；手术后6个月X线片结果：提携角范围为9°~19°，平均（14.34±3.28）°，前倾角范围为24°~51°，平均为（40.08±7.44）°，鲍曼角范围为55°~76°，平均为（67.54±6.10）°。3D模拟手术与实际手术后提携角对比，差异无统计学意义（t=1.76，P=0.1）。术后6个月随访时肘关节功能评定：优10例，良0例，一般5例，差1例。肘关节功能评分：69~100分，平均（89.00±11.62）分；与术前肘关节功能评分比较，差异无统计学意义（t=1.03，P=0.32）。结论 在小儿肘关节畸形截骨矫形术中运用3D打印技术，有助于评估畸形形态和精确设计截骨角度，截骨矫形效果符合预期。
- Abstract:
- Objective To explore the clinical application value of three-dimensional (3D) printing technology during corrective osteotomy for cubitus varus deformity (CVD) in children.Methods From June 2016 to August 2018, 16 CVD children underwent humeral osteotomy.There were 10 boys and 6 girls with an average age of 7.7 years.According to the elbow joint scoring standard of HSS (Hospital for Special Surgery), elbow joint function was evaluated preoperatively.The computed tomography (CT) scans of elbow joint were performed for constructing a computer bone model.A 1:1 proportional 3D solid model was printed and corrective osteotomy planes were designed on the basis of the above model.Then osteotomy was guided by the 3D model.And elbow joint function was evaluated at Month 6 post-operation.Carrying angle, humerotrochlear angle and Baubann’s angle were calculated by radiographic measurements.The postoperative outcomes were compared with preoperative designs to evaluate whether orthopedic efficacy accorded with expectations.Results All of them were operated under general anesthesia.After revision surgery, bone union was achieved without complications of neurovascular injuries.Results of 3D model surgical simulation:carrying angle was 13.57°±2.62°(9°-19°);radiograph at Month 6 post-operation:carrying angle (14.34°±3.28°)(9°-19°), humerotrochlear angle 40.08°±7.44°(24°-51°) and Baubann’s angle (67.54°±6.10°)(55°-76°).No significant difference existed in carrying angles (t=1.76, P=0.1).Elbow joint function was evaluated at Month 6:excellent (n=10), good (n=0), decent (n=5) and poor (n=1).Elbow joint function score was (89.00±11.62)(69-100) points.And no statistically significant difference existed in preoperative elbow joint function (t=1.03, P=0.32).Conclusion Applying 3D printing technology during osteotomy of children with elbow joint deformity enables surgeons to precisely evaluate deformities.Also 3D corrective osteotomy may be simulated.The efficacy of osteotomy fulfills expectations.
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备注/Memo
收稿日期:2020-01-09。
基金项目:重庆市万州区社会发展领域科技计划指导性项目（编号：wzstc-z201702）
通讯作者:姚明木,Email:3052679@qq.com