Computer-aided Design and Custom-made Guide in Corrective Osteotomy for Complex Femoral Deformity

• Published in: Journal of Huazhong University of Science and Technology. Medical sciences 2013-06, Vol.33 (3), p.398-405
• Main Author: 柴伟 许猛 张国强 张立海 苟文隆 倪明 陈继营
• Format: Article
• Language: English
• Subjects: Computer-Aided Design; Equipment Failure Analysis; Femur - abnormalities; Femur - diagnostic imaging; Femur - surgery; Fiducial Markers; Humans; Imaging, Three-Dimensional - methods; Medicine; Medicine & Public Health; Osteotomy - methods; Reconstructive Surgical Procedures - methods; Surgery, Computer-Assisted - methods; Tomography, X-Ray Computed - methods; X线摄影; 三维重建; 快速原型技术; 指南; 矫正; 虚拟操作; 计算机辅助设计; 骨畸形
• ISSN: 1672-0733; 1993-1352
• DOI: 10.1007/s11596-013-1131-x

Summary： Preoperative planning of corrective osteotomy with traditional radiography has limitations in regards to determining the ideal osteotomy location and orientation in three-dimensional femoral de- formities. Though a successful operation can be planned preoperatively, intraoperative contingencies might adhere to the procedural plan in the performance of operation. To efficiently perform a planned procedure, proposed is a design to implement three-dimensional reconstruction photography, based on computer-tomography （CT） scan. A custom-made guide was designed to navigate the osteotomy as planned, and additionally, a personalized intramedullary nail was used for fixation after osteotomy. Three-dimensional （3D） photography of deformed femur was established based on the CT dataset and transferred into 3D photography processing software for further planning. Osteotomy planes were de- signed and adjusted at deformity sites to correct the 3D deformities. The methodology of a custom-made osteotomy guide was introduced in femoral corrective osteotomy, for the first time, to navigate the op- eration as planned. After the virtual osteotomy and reduction of bone segments, the parameters of a custom-made intramedullary nail were measured for manufacturing. Findings Virtual operation in computer shows complete correction of the 3D deformity. The osteotomy guide, obtained by rapid-prototyping techniques, navigates mimicking surgery on rapid-prototyping model of the involved femur as planned. Internal fixation was achieved using the custom-made intramedullary nail. Interpreta- tion three-dimensional visualization introduces an advantage in preoperative planning for corrective os- teotomy of 3D femoral deformity, and the custom-made osteotomy guide is crucial to realize such a de- liberate plan during the actual procedures. The internal fixator, such as an intramedullary nail, can be modified or personalized for fixation in unique cases.