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 ORCID:

Yan HAN

https://orcid.org/0000-0002-6810-2957

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Journal of Zhejiang University SCIENCE B 2021 Vol.22 No.10 P.866-875

http://doi.org/10.1631/jzus.B2000576


3D-printed models improve surgical planning for correction of severe postburn ankle contracture with an external fixator


Author(s):  Youbai CHEN, Zehao NIU, Weiqian JIANG, Ran TAO, Yonghong LEI, Lingli GUO, Kexue ZHANG, Wensen XIA, Baoqiang SONG, Luyu HUANG, Qixu ZHANG, Yan HAN

Affiliation(s):  Department of Plastic and Reconstructive Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China; more

Corresponding email(s):   13720086335@163.com

Key Words:  Ankle contracture, Ilizarov, Postburn contracture, 3D printing, Surgical planning


Youbai CHEN, Zehao NIU, Weiqian JIANG, Ran TAO, Yonghong LEI, Lingli GUO, Kexue ZHANG, Wensen XIA, Baoqiang SONG, Luyu HUANG, Qixu ZHANG, Yan HAN. 3D-printed models improve surgical planning for correction of severe postburn ankle contracture with an external fixator[J]. Journal of Zhejiang University Science B, 2021, 22(10): 866-875.

@article{title="3D-printed models improve surgical planning for correction of severe postburn ankle contracture with an external fixator",
author="Youbai CHEN, Zehao NIU, Weiqian JIANG, Ran TAO, Yonghong LEI, Lingli GUO, Kexue ZHANG, Wensen XIA, Baoqiang SONG, Luyu HUANG, Qixu ZHANG, Yan HAN",
journal="Journal of Zhejiang University Science B",
volume="22",
number="10",
pages="866-875",
year="2021",
publisher="Zhejiang University Press & Springer",
doi="10.1631/jzus.B2000576"
}

%0 Journal Article
%T 3D-printed models improve surgical planning for correction of severe postburn ankle contracture with an external fixator
%A Youbai CHEN
%A Zehao NIU
%A Weiqian JIANG
%A Ran TAO
%A Yonghong LEI
%A Lingli GUO
%A Kexue ZHANG
%A Wensen XIA
%A Baoqiang SONG
%A Luyu HUANG
%A Qixu ZHANG
%A Yan HAN
%J Journal of Zhejiang University SCIENCE B
%V 22
%N 10
%P 866-875
%@ 1673-1581
%D 2021
%I Zhejiang University Press & Springer
%DOI 10.1631/jzus.B2000576

TY - JOUR
T1 - 3D-printed models improve surgical planning for correction of severe postburn ankle contracture with an external fixator
A1 - Youbai CHEN
A1 - Zehao NIU
A1 - Weiqian JIANG
A1 - Ran TAO
A1 - Yonghong LEI
A1 - Lingli GUO
A1 - Kexue ZHANG
A1 - Wensen XIA
A1 - Baoqiang SONG
A1 - Luyu HUANG
A1 - Qixu ZHANG
A1 - Yan HAN
J0 - Journal of Zhejiang University Science B
VL - 22
IS - 10
SP - 866
EP - 875
%@ 1673-1581
Y1 - 2021
PB - Zhejiang University Press & Springer
ER -
DOI - 10.1631/jzus.B2000576


Abstract: 
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.

3D打印模型促进外固定架矫正严重烧伤后踝关节挛缩的手术设计

目的:评估个体化3D打印模型辅助的手术设计在治疗严重烧伤后踝关节挛缩中的作用。
创新点: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。
方法: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。
结论: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。

关键词:踝关节挛缩;伊利扎洛夫技术(Ilizarov);烧伤后关节挛缩;3D打印;手术规划

Darkslateblue:Affiliate; Royal Blue:Author; Turquoise:Article

Reference

[1]BavaE, CharltonT, ThordarsonD, 2010. Ankle fracture syndesmosis fixation and management: the current practice of orthopedic surgeons. Am J Orthop, 39(5):242-246.

[2]BurzyńskaK, MorasiewiczP, FilipiakJ, 2016. The use of 3D printing technology in the Ilizarov method treatment: pilot study. Adv Clin Exp Med, 25(6):1157-1163.

[3]CalhounJH, EvansEB, HerndonDN, 1992. Techniques for the management of burn contractures with the Ilizarov fixator. Clin Orthop Relat Res, 280:117-124.

[4]CarmichaelKD, MaxwellSC, CalhounJH, 2005. Recurrence rates of burn contracture ankle equinus and other foot deformities in children treated with Ilizarov fixation. J Pediatr Orthop, 25(4):523-528.

[5]CoronaPS, VicenteM, TetsworthK, et al., 2018. Preliminary results using patient-specific 3D printed models to improve preoperative planning for correction of post-traumatic tibial deformities with circular frames. Injury, 49(S2):S51-S59.

[6]CutroneoG, BruschettaD, TrimarchiF, et al., 2016. In vivo CT direct volume rendering: a three-dimensional anatomical description of the heart. Pol J Radiol, 81:21-28.

[7]DuanXJ, FanHQ, WangFY, et al., 2019. Application of 3D-printed customized guides in subtalar joint arthrodesis. Orthop Surg, 11(3):405-413.

[8]FerreiraRC, CostaMT, 2009. Recurrent clubfoot-approach and treatment with external fixation. Foot Ankle Clin, 14(3):435-445.

[9]FitzhughA, NaveedH, DavagnanamI, et al., 2016. Proposed three-dimensional model of the orbit and relevance to orbital fracture repair. Surg Radiol Anat, 38(5):557-561.

[10]GanguliA, Pagan-DiazGJ, GrantL, et al., 2018. 3D printing for preoperative planning and surgical training: a review. Biomed Microdevices, 20(3):65.

[11]GoldsteinRY, JordanCJ, McLaurinTM, et al., 2013. The evolution of the Ilizarov technique: part 2: the principles of distraction osteosynthesis. Bull Hosp Jt Dis, 71(1):96-103.

[12]GuBK, ChoiDJ, ParkSJ, et al., 2016. 3-Dimensional bioprinting for tissue engineering applications. Biomater Res, 20:12.

[13]HuangSC, 1996. Soft tissue contractures of the knee or ankle treated by the Ilizarov technique: high recurrence rate in 26 patients followed for 3‍–6 years. Acta Orthop Scand, 67(5):443-449.

[14]IlizarovGA, 1988. The principles of the Ilizarov method. Bull Hosp Jt Dis Orthop Inst, 48(1):1-11.

[15]JordanCJ, GoldsteinRY, McLaurinTM, et al., 2013. The evolution of the Ilizarov technique: part 1: the history of limb lengthening. Bull Hosp Jt Dis, 71(1):89-95.

[16]KhodzhakulovCR, FazlitdinovN, SakhabutdinovG, 1991. The surgical treatment of postburn deformities of the foot and ankle joint. Klin Khir, 12:34-35.

[17]KitaokaHB, AlexanderIJ, AdelaarRS, et al., 1994. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 15(7):349-353.

[18]KocaoğluM, EralpL, AtalarAC, et al., 2002. Correction of complex foot deformities using the Ilizarov external fixator. J Foot Ankle Surg, 41(1):30-39.

[19]KorpK, RichardR, HawkinsD, 2015. Refining the idiom “functional range of motion” related to burn recovery. J Burn Care Res, 36(3):e136-e145.

[20]LiuJG, ZhouHT, QinHQ, et al., 2018. Comparative study of clinical efficacy using three-dimensional and two-dimensional laparoscopies in the treatment of distal gastric cancer. OncoTargets Ther, 11:301-306.

[21]LiuP, HuZC, HuangSB, et al., 2020. Application of 3D printed models of complex hypertrophic scars for preoperative evaluation and surgical planning. Front Bioeng Biotechnol, 8:115.

[22]MorasiewiczP, KoniecznyG, DejnekM, et al., 2018. Assessment of the distribution of load on the lower limbs and balance before and after ankle arthrodesis with the Ilizarov method. Sci Rep, 8:15693.

[23]PaleyD, LammBM, KatsenisD, et al., 2006. Treatment of malunion and nonunion at the site of an ankle fusion with the Ilizarov apparatus. J Bone Joint Surg, 88(1):119-134.

[24]PehdeCE, BennettJ, Lee PeckB, et al., 2020. Development of a 3-D printing laboratory for foot and ankle applications. Clin Podiatr Med Surg, 37(2):195-213.

[25]PengWM, LiuYF, JiangXF, et al., 2019. Bionic mechanical design and 3D printing of novel porous Ti6Al4V implants for biomedical applications. J Zhejiang Univ-Sci B (Biomed & Biotechnol), 20(8):647-659.

[26]PfefferGB, MichalskiMP, BasakT, et al., 2018. Use of 3D prints to compare the efficacy of three different calcaneal osteotomies for the correction of heel varus. Foot Ankle Int, 39(5):591-597.

[27]PfeilA, LehmannG, LangeU, 2018. Update DVO guidelines 2017 on “Prophylaxis, diagnostics and treatment of osteoporosis in postmenopausal women and men”: what is new, what remains for rheumatologists? Z Rheumatol, 77(9):759-763.

[28]PlochCC, CSSAMansi, JayamohanJ, et al., 2016. Using 3D printing to create personalized brain models for neurosurgical training and preoperative planning. World Neurosurg, 90:668-674.

[29]QiuB, LiuF, TangB, et al., 2017. Clinical study of 3D imaging and 3D printing technique for patient-specific instrumentation in total knee arthroplasty. J Knee Surg, 30(8):822-828.

[30]RashaanZM, StekelenburgCM, van der WalMBA, et al., 2016. Three-dimensional imaging: a novel, valid, and reliable technique for measuring wound surface area. Skin Res Technol, 22(4):443-450.

[31]RefaiMA, SongSH, SongHR, 2012. Does short-term application of an Ilizarov frame with transfixion pins correct relapsed clubfoot in children? Clin Orthop Relat Res, 470(7):1992-1999.

[32]RichtrM, SosnaA, RysavýM, 1992. Arthrodesis of the ankle by a tibiometatarsal frame. Acta Chir Orthop Traumatol Cech, 59(5):272-279.

[33]SaghiehS, el BitarY, BerjawiG, et al., 2011. Distraction histogenesis in ankle burn deformities. J Burn Care Res, 32(1):160-165.

[34]SchepersRH, KraeimaJ, VissinkA, et al., 2016. Accuracy of secondary maxillofacial reconstruction with prefabricated fibula grafts using 3D planning and guided reconstruction. J Craniomaxillofac Surg, 44(4):392-399.

[35]SobrónFB, BenjumeaA, AlonsoMB, et al., 2019. 3D printing surgical guide for talocalcaneal coalition resection: technique tip. Foot Ankle Int, 40(6):727-732.

[36]SteinwenderG, SaraphV, ZwickEB, et al., 2001. Complex foot deformities associated with soft-tissue scarring in children. J Foot Ankle Surg, 40(1):42-49.

[37]TanJL, ChenJ, ZhouJY, et al., 2019. Joint contractures in severe burn patients with early rehabilitation intervention in one of the largest burn intensive care unit in China: a descriptive analysis. Burns Trauma, 7:17.

[38]van RoermundPM, van ValburgAA, DuivemannE, et al., 1998. Function of stiff joints may be restored by Ilizarov joint distraction. Clin Orthop Relat Res, 348:220-227.

[39]von ElmE, AltmanDG, EggerM, et al., 2014. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Int J Surg, 12(12):1495-1499.

[40]YangL, ShangXW, FanJN, et al., 2016. Application of 3D printing in the surgical planning of trimalleolar fracture and doctor-patient communication. Biomed Res Int, 2016: 2482086.

[41]ZhangB, XueQ, HuHY, et al., 2019. Integrated 3D bioprinting-based geometry-control strategy for fabricating corneal substitutes. J Zhejiang Univ-Sci B (Biomed & Biotechnol), 20(12):945-959.

[42]ZhangWX, JiYP, WangXM, et al., 2017. Can the recovery of lower limb fractures be achieved by use of 3D printing mirror model? Injury, 48(11):2485-2495.

[43]ZhangZY, DouXJ, WeiZR, 2018. Treatment of knee flexion contracture with Ilizarov technology after burns. Chin J Rep Reconstr Surg, 32(10):1271-1274 (in Chinese).

[44]ZhengWH, ChenCH, ZhangCX, et al., 2018. The feasibility of 3D printing technology on the treatment of Pilon fracture and its effect on doctor-patient communication. Biomed Res Int, 2018:8054698.

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