Vergleichende Studie der präoperativen Planung und postoperativen radiologischen Resultate bei Umstellungsosteotomien nach fehlverheilter Fraktur des distalen Radius und bei Madelung Deformität mittels individualisierter Implantate

Abstract

Zusammenfassung Diese Studie untersucht, ob bei Fehlstellung nach distaler Radiusfraktur bzw. bei Madelung-Deformität eine computergestützte dreidimensional geplante Korrekturosteotomie am distalen Radius bzw. am distalen Unterarm unter Verwendung dreidimensional-gedruckter patientenspezifischer Schablonen und Plattenosteosynthesen exakt umgesetzt werden kann. Anhand dreidimensionaler computergestützter präoperativer Planung unter Orientierung an der nicht betroffenen Gegenseite wurden Säge- und Osteotomiekeil-Schablonen sowie Plattenosteosynthesen in Drucktechnik erstellt. Von insgesamt 60 Patienten aus drei verschiedenen Ländern (Deutschland, Großbritannien, Niederlande), die sich diesem Operationsverfahren unterzogen hatten, wurden prä- und postoperative operative CT-Bilder und Röntgenbilder anonymisiert ausgewertet. Hierbei wurden die präoperativen radiologischen Messwerte der Planung mit dem postoperativ erreichten Ergebnis anhand der Kriterien der radialen Länge, der Ulnavarianz sowie der Winkel Ulna- und Palmarinklination verglichen. Auf Grundlage der aktuellen Literatur wurde ein Toleranzbereich bestimmt, in dessen Grenzen die Umsetzung der präoperativen Planung als exakt gewertet wurde (±2mm für die Längen, ±3° für die Winkel). Bei der radialen Länge lagen 63,3 % der Messwerte, bei der die Ulnavarianz 100% der Messwerte innerhalb des Toleranzbereiches. Die Winkel der Palmarinklination und der Ulnainklination konnten in 83,3% und 86,7% der Fälle exakt umgesetzt werden. In der Literatur ist bislang lediglich eine Publikation zu finden, die die präoperativ geplanten mit den postoperativ erreichten radiologischen Messwerte an nur vier Fällen vergleicht (Stockmans et al., 2013). Diese Studie ist die erste, die anhand radiologischer Kriterien untersucht, ob die computergestützte dreidimensionale Planung mithilfe patientenspezifischer Schablonen und Implantaten intraoperativ exakt umgesetzt werden kann. Die Ergebnisse unterstreichen den zunehmenden Stellenwert dieses zeitaufwendigen und kostenintensiven Verfahrens.

Abstract Introduction This study investigates whether, in cases of malalignment following distal radius fracture or Madelung deformity, a computer-assisted, three-dimensionally planned corrective osteotomy on the distal radius or distal forearm can be performed with precision using three-dimensionally printed patient-specific templates and plate osteosynthesis. Based on three-dimensional computer-assisted preoperative planning using the unaffected contralateral side as a guide, saw and osteotomy wedge templates and plate osteosynthesis were created using printing technology. Pre- and post-operative CT images and X-rays from a total of 60 patients from three different countries (Germany, Great Britain, Netherlands) who had undergone this surgical procedure were evaluated anonymously. The preoperative radiological measurements from the planning were compared with the postoperative results based on the criteria of radial length, ulnar variance, and ulnar and palmar inclination angles. Based on the current literature, a tolerance range was determined within which the implementation of the preoperative planning was considered accurate (±2 mm for lengths, ±3° for angles). For radial length, 63.3% of the measurements were within the tolerance range, while for ulnar variance, 100% of the measurements were within the tolerance range. The angles of palmar inclination and ulnar inclination could be implemented exactly in 83.3% and 86.7% of cases. To date, only one publication in the literature compares the preoperative planned radiological measurements with the postoperative measurements in only four cases (Stockmans et al., 2013). This study is the first to use radiological criteria to investigate whether computer-assisted three-dimensional planning can be accurately implemented intraoperatively using patient-specific templates and implants. The results underscore the increasing importance of this time-consuming and cost-intensive procedure.

Introduction This study investigates whether, in cases of malalignment following distal radius fracture or Madelung deformity, a computer-assisted, three-dimensionally planned corrective osteotomy on the distal radius or distal forearm can be performed with precision using three-dimensionally printed patient-specific templates and plate osteosynthesis. Material-Methods Based on three-dimensional computer-assisted preoperative planning using the unaffected contralateral side as a guide, saw and osteotomy wedge templates and plate osteosynthesis were created using printing technology. Pre- and post-operative CT images and X-rays from a total of 60 patients from three different countries (Germany, Great Britain, Netherlands) who had undergone this surgical procedure were evaluated anonymously. The preoperative radiological measurements from the planning were compared with the postoperative results based on the criteria of radial length, ulnar variance, and ulnar and palmar inclination angles. Results Based on the current literature, a tolerance range was determined within which the implementation of the preoperative planning was considered accurate (±2 mm for lengths, ±3° for angles). For radial length, 63.3% of the measurements were within the tolerance range, while for ulnar variance, 100% of the measurements were within the tolerance range. The angles of palmar inclination and ulnar inclination could be implemented exactly in 83.3% and 86.7% of cases. Discussion To date, only one publication in the literature compares the preoperative planned radiological measurements with the postoperative measurements in only four cases (Stockmans et al., 2013). This study is the first to use radiological criteria to investigate whether computer-assisted three-dimensional planning can be accurately implemented intraoperatively using patient-specific templates and implants. The results underscore the increasing importance of this time-consuming and cost-intensive procedure.