背景:距骨的血管坏死(AVN)最常继发于外伤。严重距骨AVN的严重骨丢失和塌陷仍然是手术挑战。使用同种异体股骨头移植的胫骨关节固定术(TTC)有塌陷和下沉的风险。使用填充空隙的钛桁架可以减轻这一点。这项研究描述了使用新型梯形3D打印钛桁架治疗严重距骨AVN。
方法:纳入3例终末期距骨AVN患者。每位患者都接受了定制的TTC关节固定术,3D打印,梯形,桁架植入物与后足髓内钉结合。术前记录改良患者美国骨科足踝协会(AOFAS)评分,6个月,12个月,和每年的术后时间点。
结果:所有患者在一年内进展到满意的放射学愈合。随访24~48个月,平均32个月。术前改良AOFAS评分均值为5。从术后6个月开始,AOFAS评分逐渐改善。平均改良AOFAS评分从术后6个月的28分提高到术后2年的37分。
结论:定制的3D打印钛桁架为治疗严重的距骨AVN提供了有希望的结果。“梯形”设计是有利的,因为它可以保存骨骼,并符合天然跟骨的形状。所有患者在术后的序贯时间间隔均显示出预后的进行性改善。植入物提供了在关节固定术过程中抵抗塌陷和下沉的强大机械结构。
方法:四级,回顾性病例系列。
BACKGROUND: Avascular necrosis (AVN) of the talus most commonly occurs secondary to trauma. Significant bone loss and collapse in severe talar AVN remains an operative challenge. Tibiotalocalcaneal arthrodesis (TTC) using femoral head allograft is at risk of collapse and subsidence. The use of a void-filling titanium truss can mitigate against this. This study describes the use of a novel keystone shaped 3D-printed titanium truss for treatment of severe talar AVN.
METHODS: Three patients with end-stage AVN of the talus were included. Each patient underwent a TTC arthrodesis with a custom-made, 3D-printed, keystone-shaped, truss implant in conjunction with a hindfoot intramedullary nail. Modified patient American Orthopaedic Foot & Ankle Society (AOFAS) scores were recorded at the preoperative, 6-month, 12-month, and annual postoperative timepoints.
RESULTS: All patients progressed to satisfactory radiological union by one year. Mean follow up time was 32 months (24-48 months). Mean preoperative modified AOFAS score was 5. There was progressive improvement in AOFAS scores from 6 months postoperatively. Mean modified AOFAS score improved from 28 at 6 months to 37 at 2 years postoperatively.
CONCLUSIONS: Custom-made 3D-printed titanium trusses provide promising outcomes for treating severe AVN of the talus. The \"keystone\" design is advantageous as it allows for bone stock preservation and conforms to the shape of the native calcaneum. All patients showed progressive improvements in outcomes at sequential time intervals postoperatively. The implant provides a strong mechanical structure resisting collapse and subsidence during the arthrodesis process.
METHODS: Level IV, retrospective case series.