3D打印个体化导板在踝关节外侧韧带解剖重建中的应用

目的探讨3D打印个体化钻孔导板建立的腓骨通道用于韧带解剖重建治疗慢性踝关节外侧不稳定的疗效。方法回顾性分析2012年l0月至2015年6月华中科技大学附属普爱医院足踝外科收治的15例慢性踝关节外侧不稳定患者资料,男4例,女11例;年龄18~42岁,平均26.3岁。均采用3D打印个体化钻孔导板建立腓骨通道,通过腓骨通道进行韧带解剖重建。比较术前和末次随访时患者的美国足踝外科协会(AOFAS)的踝-后足评分、疼痛视觉模拟评分(VAS)。结果15例患者术后获12~18个月(平均15.2个月)随访。AOFAS的踝-后足评分由术前的(47.1±3.8)分提高至末次随访时的(88.3±4.7)分,VAS评分由术前平均(5.8±1.8)分降至末次随访时的(1.6±1.3)分,差异均有统计学意义(P<0.05)。AOFAS的踝-后足评分评价:优良11例,可4例。无严重并发症发生。结论3D打印个体化钻孔导板建立腓骨通道用于重建慢性踝关节外侧不稳定的韧带时可以精准化、个性化,且疗效肯定。

Anatomical reconstruction of the lateral ankle ligament with an individualized 3D printed drill template

Objective To evaluate the clinical application of an individualized 3D printed drill template to create a fibular channel in the anatomical reconstruction of the lateral ankle ligament for chronic lateral ankle instability.Methods From October 2012 to June 2015,15 patients with lateral ankle in-stability underwent surgery at Department of Foot and Ankle Surgery,The Fourth Hospital of Wuhan.They were 4 men and 11 women,with a mean age of 26.3 years(range,from 18 to 42 years).For each of them,anatomical reconstruction of the lateral ankle ligament was performed through a fibular channel which was created with the aid of an individualized 3D printed drill template.The American Orthopaedic Foot and Ankle Society(AOFAS)and Visual Analogue Scale(VAS)scores were used to assess the patients preoperation and at the last follow-up.Results The 15 patients obtained a mean follow-up of 15.2 months(range,from 12 to 18 months).Their preoperative AOFAS scores(47.1±3.8)were increased to 88.3±4.7 at the last fol-low-up,and their preoperative VAS scores(5.8±1.8)decreased to 1.55±1.35 at the last follow-up,showing significant differences(P<0.05).There were 11 excellent and 4 good cases by the AOFAS ankle-hindfoot scale.No significant complications were found.Conclusion In the anatomical reconstruction of the lateral ankle ligament for chronic lateral ankle instability,an individualized 3D printed drill template can help create a fibular channel which exactly fits each individual,leading to positive therapeutic effects.