Application of 3D-printed Customized Guides in Subtalar Joint Arthrodesis
Application of 3D-printed Customized Guides in Subtalar Joint Arthrodesis
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DOI：
10.1111/os.12464
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发表时间：
2019-06-01
影响因子：
2.1
通讯作者：
Yang, Liu
中科院分区：
文献类型：
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作者：
Duan, Xiao-jun;Fan, Hua-quan;Yang, Liu
目的探讨3D打印定制导轨在距下关节融合术中辅助克氏针精确钻孔的可行性。方法回顾性分析2013年7月1日至2017年12月31日期间行距下关节融合术的29例患者（30例距下关节）的资料。根据患者的计算机断层扫描（CT）数据，利用计算机模拟（MIMICS）软件中的模型肠道菌群（model Intestinal Microflora）制作全尺寸三维聚乳酸模型，并采用3D打印技术制作定制导流器。共14个关节采用定制导轨（实验组）；其余16个关节采用传统方法（对照组）。观察两组患者克氏针钻孔至正确位置的时间、距下融合时间、美国骨科足踝协会（AOFAS）评分及并发症。结果所有定制导轨均制作成功。实验组克氏针钻孔至满意位置用时2.1 +/- 0.7 min， 2例需重新钻孔；对照组克氏针钻孔至满意位置所需时间为4.6±1.9 min (P < 0.05)， 8例需重新钻孔。两组患者术中及术后均未发生严重并发症。所有病例术后x线片均证实融合。两组患者术后1年的融合时间和AOFAS评分比较，差异无统计学意义（P < 0.05）。结论在距下关节融合术中应用3d打印定制导轨是安全的，可以根据术前计划将克氏针准确钻孔到合适的位置，减少手术时间和术中辐射。
Objective To explore the feasibility of 3D printed customized guides assisting the precise drilling of Kirschner wires in subtalar joint arthrodesis. Methods We retrospectively reviewed the data of 29 patients (30 subtalar joints) who underwent subtalar joint arthrodesis between 1 July 2013 and 31 December 2017. The customized guides were designed on a full-scale 3D polylactic acid model made from computed tomography (CT) data of patients by Model Intestinal Microflora in Computer Simulation (MIMICS) software, which were manufactured by 3D printing technology. A total of 14 joints used customized guides (experimental group); the remained 16 joints used the traditional method (control group). The time of drilling the Kirschner wires to the correct position, the time of subtalar fusion, American Orthopaedic Foot & Ankle Society (AOFAS) scores, and complications were evaluated in both groups. Results All customized guides were successfully manufactured. In the experimental group, it took 2.1 +/- 0.7 min to drill the Kirschner wire to the satisfactory position, and 2 cases needed to be re-drilled; in the control group, it took 4.6 +/- 1.9 min to drill the Kirschner wire to the satisfactory position (P < 0.05), and 8 cases needed to be re-drilled. No serious complications occurred in both groups during and after the surgery. Postoperative radiographic fusion was confirmed in all cases. No significant difference was observed in the fusion time and AOFAS scores 1 year postoperatively between the two groups (P > 0.05). Conclusion It is safe to apply 3D-printed customized guides for subtalar joint arthrodesis, which can assist the accurate drilling of Kirschner wires into the appropriate position according to the preoperative plan, and reduce the operation time as well as intraoperative radiation.