CLINICAL APPLICATION OF THREE DIMENSIONAL PRINTED NAVIGATION TEMPLATES FOR TREATMENT OF OSTEONECROSIS OF FEMORAL HEAD WITH PEDICLED ILIAC BONE GRAFT_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YUKaifu ¹ ,  XUYongqing ² , TANHongbo ² , HEXiaoqing ² , CAIDixin ² , ZHOUTianhua ² , LUOHaotian ² , DUANJiazhang ¹

1. Brigade of Postgraduate Management, Third Military Medical University, Chongqing, 400038, P.R.China;
2. Department of Orthopedics, Kunming General Hospital of Chengdu Military Region;

Corresponding author：

XUYongqing, Email: xuyongqingkm@163.net

Keywords：

Osteonecrosis of femoral head; Three dimensional printing technology; Navigation template; Iliac bone flap

DOI：

10.7507/1002-1892.20160073

Video：

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Objective To investigate the feasibility and early effectiveness to treat osteonecrosis of the femoral head (ONFH) with pedicled iliac bone graft assisted by individual digital design and three dimensional (3D) printed navigation templates. Methods Between February and June 2014, 15 patients (24 hips) with ONFH underwent pedicled iliac bone graft assisted by individual digital design and 3D printed navigation templates. There were 11 males (17 hips) and 4 females (7 hips) with a mean age of 38 years (range, 18-56 years) and a mean disease duration of 7.5 months (range, 1-24 months); the left hip was involved in 2 cases, the right hip in 4 cases, and both hips in 9 cases. There were 7 cases (12 hips) of steroid-induced ONFH, 5 cases (8 hips) of alcohol-induced ONFH, 1 case (1 hip) of traumatic ONFH, and 2 cases (3 hips) of idiopathic ONFH. The preoperative Harris score was 56.60±6.97. According to Association Research Circulation Osseous (ARCO) staging system, 5 hips were classified as stage IIB, 8 hips as stage IIC, 6 hips as stage IIIB, and 5 hips as stage IIIC. The navigation templates were designed and printed to assist accurate location and debridement of necrosis area according to preoperative CT scanning at the beginning of pedicled iliac bone grafting procedure. Results The mean operation time was 135 minutes (range, 120-160 minutes), mean amount of bleeding was 255 mL (range, 200-300 mL). All the wounds healed primarily, no complication of deep vein thrombosis or infection was observed. All patients were followed up 12-16 months (mean, 14 months). The location of necrosis area was in accordance with preoperative design, which was removed completely without penetration of joint surface, pedicled iliac bone graft was performed at the right site according to postoperative imaging examination. Radiographically, graft fusion was achieved at 2.7 months (range, 2-3 months) in all patients. All the hips had no collapse during follow-up. Hip pain was relieved, and range of motion was improved. The Harris score was significantly improved to 89.53±5.83 at last follow-up (t=14.319, P=0.000). The results were excellent in 12 hips, good in 10 hips, and fair in 2 hips according to Harris score standard. Conclusion Pedicled iliac bone graft assisted by individual digital design and 3D printed navigation templates for treatment of adult ONFH has the advantages of accurate location and complete debridement of necrosis area, so satisfactory results can be obtained.

Citation： YUKaifu, XUYongqing, TANHongbo, HEXiaoqing, CAIDixin, ZHOUTianhua, LUOHaotian, DUANJiazhang. CLINICAL APPLICATION OF THREE DIMENSIONAL PRINTED NAVIGATION TEMPLATES FOR TREATMENT OF OSTEONECROSIS OF FEMORAL HEAD WITH PEDICLED ILIAC BONE GRAFT. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(3): 373-377. doi: 10.7507/1002-1892.20160073 Copy

1.	Marker DR, Seyler TM, McGrath MS, et al. Treatment of early stage osteonecrosis of the femoral head. J Bone Joint Surg (Am), 2008, 90 Suppl 4: 175-187.
2.	Mont MA, Hungerford DS. Non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg (Am), 1995, 77(3): 459-474.
3.	Nakamura Y, Kumazawa Y, Mitsui H, et al. Combined rotational osteotomy and vascularized iliac bone graft for advanced osteonecrosis of the femoral head. J Reconstr Microsurg, 2005, 21(2): 101-105.
4.	Zhao D, Zhang Y, Wang W, et al. Tantalum rod implantation and vascularized iliac grafting for osteonecrosis of the femoral head. Orthopedics, 2013, 36(6): 789-795.
5.	Elmali N, Ertem K, Karakaplan M, et al. Vascular pedicled iliac bone grafting is effective in patients with an early stage of femoral head avascular necrosis. Eklem Hastalik Cerrahisi, 2014, 25(1): 2-7.
6.	Zhao D, Liu B, Wang B, et al. Autologous bone marrow mesenchymal stem cells associated with tantalum rod implantation and vascularized iliac grafting for the treatment of end-stage osteonecrosis of the femoral head. Biomed Res Int, 2015, 2015: 240506.
7.	Babhulkar S. Osteonecrosis of femoral head: Treatment by core decompression and vascular pedicle grafting. Indian J Orthop, 2009, 43(1): 27-35.
8.	徐永清, 范新宇, 唐辉, 等.旋股外动脉升支血管蒂髂骨瓣移植治疗成人股骨头坏死的临床分析.中华关节外科杂志(电子版), 2012, 6(2): 192-195.
9.	张长青, 曾炳芳, 眭述平, 等.改良吻合血管游离腓骨移植治疗股骨头缺血性坏死的手术技术.中国修复重建外科杂志, 2005, 19(9): 692-696.
10.	童德迪, 陈山林, 荣艳波, 等.术中三维计算机导航辅助吻合血管的腓骨移植治疗股骨头缺血坏死的临床研究.中华显微外科杂志, 2014, 37(4): 328-333.
11.	Chung KJ, Hong do Y, Kim YT, et al. Preshaping plates for minimally invasive fixation of calcaneal fractures using a real-size 3D-printed model as a preoperative and intraoperative tool. Foot Ankle Int, 2014, 35(11): 1231-1236.
12.	Jeong HS, Park KJ, Kil KM, et al. Minimally invasive plate osteosynthesis using 3D printing for shaft fractures of clavicles: technical note. Arch Orthop Trauma Surg, 2014, 134(11): 1551-1555.
13.	Kunz M, Ma B, Rudan JF, et al. Image-guided distal radius osteotomy using patient-specific instrument guides. J Hand Surg Am, 2013, 38(8): 1618-1624.
14.	Tricot M, Duy KT, Docquier PL. 3D-corrective osteotomy using surgical guides for posttraumatic distal humeral deformity. Acta Orthop Belg, 2012, 78(4): 538-542.
15.	Lu S, Xu YQ, Lu WW, et al. A novel patient-specific navigational template for cervical pedicle screw placement. Spine (Phila Pa 1976), 2009, 34(26): E959-966.
16.	Won SH, Lee YK, Ha YC, et al. Improving pre-operative planning for complex total hip replacement with a Rapid Prototype model enabling surgical simulation. Bone Joint J, 2013, 95-B(11): 1458-1463.
17.	Omori S, Murase T, Kataoka T, et al. Three-dimensional corrective osteotomy using a patient-specific osteotomy guide and bone plate based on a computer simulation system: accuracy analysis in a cadaver study. Int J Med Robot, 2014, 10(2): 196-202.
18.	付军, 王臻, 郭征, 等.数字化结合3D打印个体化导板的设计加工及其在骨肿瘤手术中的应用.中华创伤骨科杂志, 2015, 17(1): 50-54.
19.	张进, 田家亮, 孙立, 等.数字化设计结合3D打印个性化经皮导板在肩关节周围穿刺中的初步应用.中华创伤骨科杂志, 2015, 17(1): 45-49.
20.	van Dijk M, Smit TH, Jiya TU, et al. Polyurethane real-size models used in planning complex spinal surgery. Spine (Phila Pa 1976), 2001, 26(17): 1920-1926.

1. Marker DR, Seyler TM, McGrath MS, et al. Treatment of early stage osteonecrosis of the femoral head. J Bone Joint Surg (Am), 2008, 90 Suppl 4: 175-187.
2. Mont MA, Hungerford DS. Non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg (Am), 1995, 77(3): 459-474.
3. Nakamura Y, Kumazawa Y, Mitsui H, et al. Combined rotational osteotomy and vascularized iliac bone graft for advanced osteonecrosis of the femoral head. J Reconstr Microsurg, 2005, 21(2): 101-105.
4. Zhao D, Zhang Y, Wang W, et al. Tantalum rod implantation and vascularized iliac grafting for osteonecrosis of the femoral head. Orthopedics, 2013, 36(6): 789-795.
5. Elmali N, Ertem K, Karakaplan M, et al. Vascular pedicled iliac bone grafting is effective in patients with an early stage of femoral head avascular necrosis. Eklem Hastalik Cerrahisi, 2014, 25(1): 2-7.
6. Zhao D, Liu B, Wang B, et al. Autologous bone marrow mesenchymal stem cells associated with tantalum rod implantation and vascularized iliac grafting for the treatment of end-stage osteonecrosis of the femoral head. Biomed Res Int, 2015, 2015: 240506.
7. Babhulkar S. Osteonecrosis of femoral head: Treatment by core decompression and vascular pedicle grafting. Indian J Orthop, 2009, 43(1): 27-35.
8. 徐永清, 范新宇, 唐辉, 等.旋股外动脉升支血管蒂髂骨瓣移植治疗成人股骨头坏死的临床分析.中华关节外科杂志(电子版), 2012, 6(2): 192-195.
9. 张长青, 曾炳芳, 眭述平, 等.改良吻合血管游离腓骨移植治疗股骨头缺血性坏死的手术技术.中国修复重建外科杂志, 2005, 19(9): 692-696.
10. 童德迪, 陈山林, 荣艳波, 等.术中三维计算机导航辅助吻合血管的腓骨移植治疗股骨头缺血坏死的临床研究.中华显微外科杂志, 2014, 37(4): 328-333.
11. Chung KJ, Hong do Y, Kim YT, et al. Preshaping plates for minimally invasive fixation of calcaneal fractures using a real-size 3D-printed model as a preoperative and intraoperative tool. Foot Ankle Int, 2014, 35(11): 1231-1236.
12. Jeong HS, Park KJ, Kil KM, et al. Minimally invasive plate osteosynthesis using 3D printing for shaft fractures of clavicles: technical note. Arch Orthop Trauma Surg, 2014, 134(11): 1551-1555.
13. Kunz M, Ma B, Rudan JF, et al. Image-guided distal radius osteotomy using patient-specific instrument guides. J Hand Surg Am, 2013, 38(8): 1618-1624.
14. Tricot M, Duy KT, Docquier PL. 3D-corrective osteotomy using surgical guides for posttraumatic distal humeral deformity. Acta Orthop Belg, 2012, 78(4): 538-542.
15. Lu S, Xu YQ, Lu WW, et al. A novel patient-specific navigational template for cervical pedicle screw placement. Spine (Phila Pa 1976), 2009, 34(26): E959-966.
16. Won SH, Lee YK, Ha YC, et al. Improving pre-operative planning for complex total hip replacement with a Rapid Prototype model enabling surgical simulation. Bone Joint J, 2013, 95-B(11): 1458-1463.
17. Omori S, Murase T, Kataoka T, et al. Three-dimensional corrective osteotomy using a patient-specific osteotomy guide and bone plate based on a computer simulation system: accuracy analysis in a cadaver study. Int J Med Robot, 2014, 10(2): 196-202.
18. 付军, 王臻, 郭征, 等.数字化结合3D打印个体化导板的设计加工及其在骨肿瘤手术中的应用.中华创伤骨科杂志, 2015, 17(1): 50-54.
19. 张进, 田家亮, 孙立, 等.数字化设计结合3D打印个性化经皮导板在肩关节周围穿刺中的初步应用.中华创伤骨科杂志, 2015, 17(1): 45-49.
20. van Dijk M, Smit TH, Jiya TU, et al. Polyurethane real-size models used in planning complex spinal surgery. Spine (Phila Pa 1976), 2001, 26(17): 1920-1926.

Chinese Journal of Reparative and Reconstructive Surgery

CLINICAL APPLICATION OF THREE DIMENSIONAL PRINTED NAVIGATION TEMPLATES FOR TREATMENT OF OSTEONECROSIS OF FEMORAL HEAD WITH PEDICLED ILIAC BONE GRAFT

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