3D打印导板8字骨骺阻滞钢板矫正儿童下肢畸形△

3D printed guider for 8 shaped plate placement in epiphysiodesis for correction of lower limb deformities in children

摘要:

[目的] 评价 3D 打印导板辅助 8 字骨骺阻滞钢板矫正儿童下肢畸形的临床效果。[方法] 2016 年 1 月—2018 年 12 月共 37 例双侧膝外翻或膝内翻患儿纳入本研究并随机分为两组，其中，20 例采用 3DP 导板引导下钢板置入，17 例采用传统徒手技术置入钢板。比较两组患儿围手术期、随访和影像资料。[结果]所有患儿均顺利完成手术，无严重并发症。导板组手术时间、钢板置入时间和透视次数均显著优于徒手组(P＜0.05)。所有患儿均获随访 12 月以上，与术前相比，末次随访时，两组患儿双下肢平均长度均显著增加 (P＜0.05)，而双侧膝关节平均 ROM 无明显改变 (P＞0.05)。相应时间点，两组双下肢平均长度和双侧膝关节平均 ROM 的差异均无统计学意义 (P＞0.05)。影像方面，与术前相比，末次随访时，两组患儿 FTA、mMP- TA、mLDFA 均显著改善 (P＜0.05)，双侧下肢长度差稍降低，但差异无统计学意义 (P＞0.05)，相应时间点，两组间上述影像指标的差异均无统计学意义(P＞0.05)。[结论]本研究设计的 3DP 个体化导板减少了儿童下肢畸形 8 字钢板骨骺阻滞术手术时间和术中 X 射线暴露次数，可辅助 8 字钢板精准置入。

Abstract:

[Objective] To evaluate the clinical results of 3D printed guider assisted epiphyseal block plate placement in correction of lower limb deformities in children. [Methods] From January 2016 to December 2018, a total of 37 children with bilateral genu varus or genu varus were enrolled in this study, and randomly divided into two groups. Among them, 20 children had the plate inserted with assistance of the 3D printed guider, while the remaining 17 patients had the plate implanted with traditional free-hand technique. Perioperative, followup and imaging data of the two groups were compared. [Results] All the children were operated on successfully without serious complica- tions. The guider group proved significantly superior to the free-hand group in terms of operation time, plate placement time and fluoroscopy times (P＜0.05) . All patients were followed up for more than 12 months. The length of lower limbs significantly increased (P＜0.05) , whereas the knee range of motion (ROM) remained unchanged at the latest follow up compared with those preoperatively (P＜0.05) . At any corre- sponding time points, there were no significant differences in the length of lower limbs and the ROM between the two groups (P＞0.05) . In terms of imaging evaluation, the femorotibial angle (FTA) , mechanical medial proximal tibial angle (mMPTA) and mechanical lateral distal femoral angle (mLDFA) significantly improved in both groups at the latest follow-up compared with those preoperatively (P＜0.05) , while the discrepancy in bilateral lower limb length was slightly decreased without statistically significant differences (P＞0.05) . However, there were no significant differences in abovementioned radiographic items between the two groups at any corresponding time points (P＞0.05) . [Conclusion] The personalized 3D printed guider designed in this study does reduce the operation time and the number of intraoperative X-ray expo- sure during 8 shaped plate placement in epiphysiodesis for correction of lower limb deformities in children.