Gradual distraction with an external fixator is a widely used treatment for severe postburn ankle contracture (SPAC). However, application of external fixators is complex, and conventional two-dimensional (2D) imaging-based surgical planning is not particularly helpful due to a lack of spatial geometry. The purpose of this study was to evaluate the surgical planning process for this procedure with patient-specific three-dimension-printed models (3DPMs). In this study, patients coming from two centers were divided into two cohorts (3DPM group vs. control group) depending on whether a 3DPM was used for preoperative surgical planning. Operation duration, improvement in metatarsal-tibial angle (MTA), range of motion (ROM), the American Orthopedic Foot and Ankle Society (AOFAS) scores, complications, and patient-reported satisfaction were compared between two groups. The 3DPM group had significantly shorter operation duration than the control group ((2.0±0.3) h vs. (3.2± 0.3) h, P<0.01). MTA, ROM, and AOFAS scores between the two groups showed no significant differences pre-operation, after the removal of the external fixator, or at follow-up. Plantigrade feet were achieved and gait was substantially improved in all patients at the final follow-up. Pin-tract infections occurred in two patients (one in each group) during distraction and were treated with wound care and oral antibiotics. Patients in the 3DPM group reported higher satisfaction than those in the control group, owing to better patient-surgeon communication. Surgical planning using patient-specific 3DPMs significantly reduced operation duration and increased patient satisfaction, while providing similar improvements in ankle movement and function compared to traditional surgical planning for the correction of SPAC with external fixators.
首次将3D打印模型应用于矫正严重烧伤后踝关节挛缩手术设计中. 3D打印模型辅助手术设计显著缩短了手术时间, 提高了患者满意度.
本研究纳入了来自解放军总医院第一医学中心和空军军医大学第一附属医院的10名患者. 根据术前是否使用3D打印模型进行手术设计, 将患者分为两组(3D打印模型组和传统手术组). 研究的主要结局指标是手术时间. 其他结局指标包括跖胫骨角(MTA)、 踝关节活动范围(ROM)、 美国骨科足踝协会评分(AOFAS scores)、 并发症和患者满意度.
与传统术前手术计划相比, 使用定制3D打印模型的手术设计显著缩短了手术时间, 提高了患者满意度. 两组踝关节运动和功能方面改善程度无差别.
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Yan HAN, Youbai CHEN, and Zehao NIU drafted the manuscript and designed the study. Youbai CHEN, Zehao NIU, and Weiqian JIANG collected the data and performed the data analysis. Yan HAN, Yonghong LEI, Ran TAO, and Lingli GUO performed part of the surgeries. Wensen XIA, Baoqiang SONG, Luyu HUANG, Kexue ZHANG, and Qixu ZHANG measured MTA, ROM, AOFAS, and hindfoot scores. All authors have read and approved the final manuscript and, therefore, have full access to all the data in the study and take responsibility for the integrity and security of the data.
Compliance with ethics guidelines
Youbai CHEN, Zehao NIU, Weiqian JIANG, Ran TAO, Yonghong LEI, Lingli GUO, Kexue ZHANG, Wensen XIA, Baoqiang SONG, Luyu HUANG, Qixu ZHANG, and Yan HAN declare that they have no conflict of interest.
All procedures followed were approval by the Institutional Ethics Committees of Chinese PLA General Hospital (Approval ID: S2021-241-01). All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5). Informed consent was obtained from all patients for being included in the study.
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Chen, Y., Niu, Z., Jiang, W. et al. 3D-printed models improve surgical planning for correction of severe postburn ankle contracture with an external fixator. J. Zhejiang Univ. Sci. B 22, 866–875 (2021). https://doi.org/10.1631/jzus.B2000576
- Ankle contracture
- Postburn contracture
- 3D printing
- Surgical planning