3D打印导板辅助外翻截骨矫正严重髋内翻畸形  

3D printed guider assisted valgus osteotomy for correction of severe coxa vara deformity secondary to dysplasia fibrous

作　　者：王志伟 廖瞻[1] 万军[1] 罗伟[1] 何洪波[1] WANG Zhi-wei;LIAO Zhan;WAN Jun;LUO Wei;HE Hong-bo(Department of Orthopedics,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院骨病专科,湖南长沙410008

出　　处：《中国矫形外科杂志》2021年第11期1024-1026,共3页Orthopedic Journal of China

摘　　要：[目的]介绍3D打印截骨导板辅助外翻截骨矫正骨纤维结构不良严重髋内翻畸形的手术技术和初步临床结果。[方法]2012年10月—2017年12月采用3D打印导板辅助外翻截骨矫正19例骨纤维结构不良髋内翻畸形患者。根据术前CT行计算机模拟截骨,设计3D打印截骨导板,术中截骨导板辅助截骨。15例患者采用病灶刮除骨水泥填充+外翻截骨+DHS固定,4例患者采用外翻截骨+DHS固定。[结果]所有患者均顺利完成手术。末次随访时,改良Guille评分(8.53±1.07)分,临床效果评定为优11例,良7例,中1例,差0例。末次随访截骨端均愈合,平均愈合时间(3.87±0.97)个月,末次随访时颈干角为(121.89±7.40)°,患肢短缩平均(0.67±0.51)cm。所有患者未出现畸形复发、内固定失效、截骨端不愈合等并发症。[结论]3D打印截骨导板辅助外翻截骨在术前设计基础上实现术中精确截骨,恢复颈干角,纠正患肢短缩,改善患肢功能,是治疗骨纤维结构不良髋内翻畸形的有效手术方法。[Objective]To introduce the surgical technique and preliminary clinical outcomes of 3D printed guider assisted valgus osteotomy for correction of coxa vara deformity secondary to fibrous dysplasia.[Methods]From October 2012 to December 2017,19 patients underwent surgical correction of coxa vara deformity in our department.The 3D printed patient-specific guider and instrumentation were designed and made according to the preoperative CT data.With the assistance of 3D printed guider and instrumentation,the surgical treatment combined deformity correction was finished in the 19 patients.Of them,15 patients had the lesion removed by curettage,followed by bone cement filling,osteotomy and DHS fixation,while the remaining 4 patients were treated with osteotomy and DHS fixation.[Results]All patients had operations completed successfully.At the latest follow-up,the modified Guille score was of(8.53±1.07)on average,with clinical outcomes graded as excellent in 11 cases,good in 7 cases,fair in 1 case and poor in 0 case.In term of radiographic evaluation,all patients got the osteotomy healed in(3.87±0.97)months on average,with femoral neck-shaft angle of(121.89±7.40)°and affected limb shortening of(0.67±0.51)cm on average.There were no complications,such as recurrence of deformity,failure of internal fixation,nonunion of osteotomy in anyone of them.[Conclusion]The 3D printed guider and instrumentation do facilitate to achieve precise osteotomy,restore the neck-stem angle,correct the shortening of the affected limb,and improve the function of the affected limb in the valgus osteotomy,which is an effective surgical technique for correction of coxa vara deformity secondary to fibrous dysplasia.

关 键 词：骨纤维结构不良 3D打印截骨导板 截骨 髋内翻 牧羊人手杖畸形 

分 类 号：R687.4[医药卫生—骨科学]