Application of three-dimensional navigation template in adult cubitus varus osteotomy_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANG Erping ^1,2 , CHANG Zuhao ¹ ,  CHEN Hua ¹

1. Department of Orthopedics, First Medical Center of Chinese PLA General Hospital, Beijing, 100853, P.R.China;
2. Department of Orthopedics, Huanggang Central Hospital, Huanggang Hubei, 438000, P.R.China;

Corresponding author：

CHEN Hua, Email: chenhua0270@126.com

Keywords：

Cubitus varus deformity; three-dimensional navigation template; osteotomy; three-dimensional printing; adults

DOI：

10.7507/1002-1892.201906117

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Objective To investigate the effectiveness of three-dimensional (3D) navigation template in the adult cubitus varus osteotomy.Methods Between April 2013 and September 2015, 17 patients with cubitus varus were admitted. There were 6 males and 11 females, aged from 19 to 38 years, with an average age of 26.9 years. There were 10 cases of left elbow joints and 7 cases of right elbow joints. The disease duration was 9-30 years (mean, 18 years). Based on the preoperative X-ray film, the humerus-elbow-wrist (HEW) angle was (−13.2 ±3.3)°, the anteversion angle was (−10.5±2.3)°. The preoperative range of motion (ROM) of flexion was (127.3±7.3)° and ROM of extension was (−10.0±2.5)°. Based on the CT 3D reconstruction, the osteotomy navigation template was designed and printed by 3D printing technique. The cubitus varus osteotomy was assisted by 3D navigation template. The postoperative HEW angle, anteversion angle, and ROMs of the elbow joints of both sides were measured. The elbow function was evaluated based on the Oppenheim elbow function score at 1 year after operation.Results All cubitus varus osteotomies succeeded with the assist of 3D navigation template. All incisions healed by first intention. All patients were followed up 12-15 months (mean, 13 months). X-ray films showed that all osteotomies healed after 9-12 weeks (mean, 11 weeks). At 1 year after operation, the HEW angle was (9.7±1.9)°, the anteversion angle was (20.7±4.3)°, the ROM was (2.6±3.5)° in extension and (139.2±4.8)° in flexion of affected side. The HEW angle, anteversion angle, and ROMs significantly increased compared with preoperative values (P<0.05). And there was no significant difference between affected and normal elbow joints (P>0.05). The elbow functions were excellent in 13 cases and good in 4 cases based on the Oppenheim elbow function score at 1 year after operation. There was no complication such as the nerve injury or osteomyositis of elbow joint during follow-up. Conclusion The 3D navigation template can provide a personalized and precise osteotomy treatment for adult cubitus varus deformity and obtain a satisfactory effectiveness.

Citation： YANG Erping, CHANG Zuhao, CHEN Hua. Application of three-dimensional navigation template in adult cubitus varus osteotomy. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(7): 831-835. doi: 10.7507/1002-1892.201906117 Copy

1.	Takeyasu Y, Murase T, Miyake J, et al. Three-dimensional analysis of cubitus varus deformity after supracondylar fractures of the humerus. J Shoulder Elbow Surg, 2011, 20(3): 440-448.
2.	张川, 张作君, 蔡鸿敏, 等. 双平面截骨矫形并外侧解剖锁定板固定治疗成人肘内翻畸形. 中国修复重建外科杂志, 2017, 31(10): 1173-1178.
3.	Pankaj A, Dua A, Malhotra R, et al. Dome osteotomy for posttraumatic cubitus varus: a surgical technique to avoid lateral condylar prominence. J Pediatr Orthop, 2006, 26(1): 61-66.
4.	Gong HS, Chung MS, Oh JH, et al. Oblique closing wedge osteotomy and lateral plating for cubitus varus in adults. Clin Orthop Relat Res, 2008, 466(4): 899-906.
5.	Mishra PK, Verma AK, Dwivedi R, et al. Reverse V osteotomy and treatment of cubitus varus deformity-Results and experience. J Clin Orthop Trauma, 2016, 7(Suppl 2): 154-160.
6.	Jeon IH, Oh CW, Kyung HS, et al. Tardy ulnar nerve palsy in cubitus varus deformity associated with ulnar nerve dislocation in adults. J Shoulder Elbow Surg, 2006, 15(4): 474-478.
7.	O’Driscoll SW, Spinner RJ, McKee MD, et al. Tardy posterolateral rotatory instability of the elbow due to cubitus varus. J Bone Joint Surg (Am), 2001, 83(9): 1358-1369.
8.	王庆伟, 王华松, 黄继锋, 等. 设计并应用改良肱骨髁上等腰三角形截骨矫形治疗肘内翻畸形. 中华创伤骨科杂志, 2018, 20(1): 16-21.
9.	Raney EM, Thielen Z, Gregory S, et al. Complications of supracondylar osteotomies for cubitus varus. J Pediatr Orthop, 2012, 32(3): 232-240.
10.	Takeyasu Y, Murase T, Miyake J, et al. Three-dimensional analysis of cubitus varus deformity after supracondylar fractures of the humerus. J Shoulder Elbow Surg, 2011, 20(3): 440-448.
11.	Takagi T, Takayama S, Nakamura T, et al. Supracondylar osteotomy of the humerus to correct cubitus varus: do both internal rotation and extension deformities need to be corrected? J Bone Joint Surg (Am), 2010, 92(7): 1619-1626.
12.	Kim HT, Lee JS, Yoo CI. Management of cubitus varus and valgus. J Bone Joint Surg (Am), 2005, 87(4): 771-780.
13.	Oppenheim WL, Clader TJ, Smith C, et al. Supracondylar humeral osteotomy for traumatic childhood cubitus varus deformity. Clin Orthop, 1984, 188: 34-39.
14.	Bovid KM, Kohler EJ, Habeck JM, et al. Utilization of a 3D-printed model for preoperative planning and operative osteotomy of a pediatric cubitus varus deformity. JSES Open Access, 2019, 3(3): 219-224.
15.	Zhang YW, Xiao X, Gao WC, et al. Efficacy evaluation of three-dimensional printing assisted osteotomy guide plate in accurate osteotomy of adolescent cubitus varus deformity. J Orthop Surg Res, 2019, 14(1): 353-356.
16.	曾俊, 林旭, 钟泽莅, 等. 个体化经皮空心螺钉内固定治疗 HerbertⅠb 型腕舟骨骨折的临床研究. 中国修复重建外科杂志, 2016, 30(10): 1189-1194.
17.	徐燕, 刘帅, 胡军, 等. 3D 打印导航模板辅助 Ludloff 截骨矫形术治疗中重度踇外翻. 中国修复重建外科杂志, 2018, 32(7): 906-911.
18.	Oka K, Murase T, Okada K, et al. Single-plane rotational osteotomy for cubitus varus deformity based on preoperative computer simulation. J Orthop Sci, 2019, 24(5): 945-951.
19.	蔡雨卫, 段敬瑞, 房雷, 等. 3D 打印辅助微创接骨板内固定术治疗不同类型胫骨骨折抗胫骨旋转不良差异研究. 中国修复重建外科杂志, 2019, 33(12): 1510-1515.
20.	Ibrahim MA, Ismail MSAM. Corrective osteotomy and in situ fusion for late-presenting nonunion of lateral condyle fractures of the humerus in adults. J Shoulder Elbow Surg, 2019, 28(3): 520-524.
21.	Yun YH, Shin SJ, Moon JG. Reverse V osteotomy of the distal humerus for the correction of cubitus varus. J Bone Joint Surg Br, 2007, 89(4): 527-531.
22.	Oka K, Murase T, Okada K, et al. Single-plane rotational osteotomy for cubitus varus deformity based on preoperative computer simulation. J Orthop Sci, 2019, 24(5): 945-951.
23.	Lim TK, Koh KH, Lee DK, et al. Corrective osteotomy for cubitus varus in middle-aged patients. J Shoulder Elbow Surg, 2011, 20(6): 866-872.

1. Takeyasu Y, Murase T, Miyake J, et al. Three-dimensional analysis of cubitus varus deformity after supracondylar fractures of the humerus. J Shoulder Elbow Surg, 2011, 20(3): 440-448.
2. 张川, 张作君, 蔡鸿敏, 等. 双平面截骨矫形并外侧解剖锁定板固定治疗成人肘内翻畸形. 中国修复重建外科杂志, 2017, 31(10): 1173-1178.
3. Pankaj A, Dua A, Malhotra R, et al. Dome osteotomy for posttraumatic cubitus varus: a surgical technique to avoid lateral condylar prominence. J Pediatr Orthop, 2006, 26(1): 61-66.
4. Gong HS, Chung MS, Oh JH, et al. Oblique closing wedge osteotomy and lateral plating for cubitus varus in adults. Clin Orthop Relat Res, 2008, 466(4): 899-906.
5. Mishra PK, Verma AK, Dwivedi R, et al. Reverse V osteotomy and treatment of cubitus varus deformity-Results and experience. J Clin Orthop Trauma, 2016, 7(Suppl 2): 154-160.
6. Jeon IH, Oh CW, Kyung HS, et al. Tardy ulnar nerve palsy in cubitus varus deformity associated with ulnar nerve dislocation in adults. J Shoulder Elbow Surg, 2006, 15(4): 474-478.
7. O’Driscoll SW, Spinner RJ, McKee MD, et al. Tardy posterolateral rotatory instability of the elbow due to cubitus varus. J Bone Joint Surg (Am), 2001, 83(9): 1358-1369.
8. 王庆伟, 王华松, 黄继锋, 等. 设计并应用改良肱骨髁上等腰三角形截骨矫形治疗肘内翻畸形. 中华创伤骨科杂志, 2018, 20(1): 16-21.
9. Raney EM, Thielen Z, Gregory S, et al. Complications of supracondylar osteotomies for cubitus varus. J Pediatr Orthop, 2012, 32(3): 232-240.
10. Takeyasu Y, Murase T, Miyake J, et al. Three-dimensional analysis of cubitus varus deformity after supracondylar fractures of the humerus. J Shoulder Elbow Surg, 2011, 20(3): 440-448.
11. Takagi T, Takayama S, Nakamura T, et al. Supracondylar osteotomy of the humerus to correct cubitus varus: do both internal rotation and extension deformities need to be corrected? J Bone Joint Surg (Am), 2010, 92(7): 1619-1626.
12. Kim HT, Lee JS, Yoo CI. Management of cubitus varus and valgus. J Bone Joint Surg (Am), 2005, 87(4): 771-780.
13. Oppenheim WL, Clader TJ, Smith C, et al. Supracondylar humeral osteotomy for traumatic childhood cubitus varus deformity. Clin Orthop, 1984, 188: 34-39.
14. Bovid KM, Kohler EJ, Habeck JM, et al. Utilization of a 3D-printed model for preoperative planning and operative osteotomy of a pediatric cubitus varus deformity. JSES Open Access, 2019, 3(3): 219-224.
15. Zhang YW, Xiao X, Gao WC, et al. Efficacy evaluation of three-dimensional printing assisted osteotomy guide plate in accurate osteotomy of adolescent cubitus varus deformity. J Orthop Surg Res, 2019, 14(1): 353-356.
16. 曾俊, 林旭, 钟泽莅, 等. 个体化经皮空心螺钉内固定治疗 HerbertⅠb 型腕舟骨骨折的临床研究. 中国修复重建外科杂志, 2016, 30(10): 1189-1194.
17. 徐燕, 刘帅, 胡军, 等. 3D 打印导航模板辅助 Ludloff 截骨矫形术治疗中重度踇外翻. 中国修复重建外科杂志, 2018, 32(7): 906-911.
18. Oka K, Murase T, Okada K, et al. Single-plane rotational osteotomy for cubitus varus deformity based on preoperative computer simulation. J Orthop Sci, 2019, 24(5): 945-951.
19. 蔡雨卫, 段敬瑞, 房雷, 等. 3D 打印辅助微创接骨板内固定术治疗不同类型胫骨骨折抗胫骨旋转不良差异研究. 中国修复重建外科杂志, 2019, 33(12): 1510-1515.
20. Ibrahim MA, Ismail MSAM. Corrective osteotomy and in situ fusion for late-presenting nonunion of lateral condyle fractures of the humerus in adults. J Shoulder Elbow Surg, 2019, 28(3): 520-524.
21. Yun YH, Shin SJ, Moon JG. Reverse V osteotomy of the distal humerus for the correction of cubitus varus. J Bone Joint Surg Br, 2007, 89(4): 527-531.
22. Oka K, Murase T, Okada K, et al. Single-plane rotational osteotomy for cubitus varus deformity based on preoperative computer simulation. J Orthop Sci, 2019, 24(5): 945-951.
23. Lim TK, Koh KH, Lee DK, et al. Corrective osteotomy for cubitus varus in middle-aged patients. J Shoulder Elbow Surg, 2011, 20(6): 866-872.

Chinese Journal of Reparative and Reconstructive Surgery

Application of three-dimensional navigation template in adult cubitus varus osteotomy

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