Precise reconstruction of digital joint defect by autogenous toe joint transplantation assisted by 3D printing technology

doi:10.3969/j.issn.2095-4344.1983

Abstract

Abstract:

BACKGROUND: The types of hand injuries in modern industry have changed to small defects of soft tissue, bone or joint. Autogenous toe joint transplantation is still the most commonly method to repair the traumatic defect of the digital joint.
OBJECTIVE: To investigate the surgical process of repairing the hand facet joint defect by digital experiment simulation with toe joint flap transplantation, and to realize the accurate interception and reconstruction of the transplanted joint through 3D printing navigation module.
METHODS: Totally 13 cases with proximal interphalangeal joint defect (13 fingers) were included in this clinical study. Proximal interphalangeal joint defect of finger was repaired by free transplantation of vascularized osteoarthrocutaneous flaps of the ipsilateral second toe as planned. The implementation process was divided into digital design group and realistic surgery group. All patients signed informed consent. This study was approved by the Hospital Ethics Committee. Digital design group was implemented with digital simulation surgery. Virtual X-ray was used to measure parameters such as the axial length of the proximal middle phalanx, the inclination of proximal interphalangeal joint surface, and the rotation axis deviation. With the help of the coadapted reference osteotomy plane in digital design group, the navigation module of digital and phalangeal osteotomy was made and 3D printed into a solid tool. 3D printed osteotomy navigation was used in realistic surgery group to perform accurate osteotomy of finger and phalanges, and carries out joint transplantation, fixation and vascular anastomosis as planned. Postoperative CT scans were carried in realistic surgery group and the morphological parameters were measured using the virtual X-ray. Paired t-test was used to compare the postoperative morphological parameters of realistic surgery group with the digital design group.
RESULTS AND CONCLUSION: (1) All the 13 fingers of 13 cases survived and achieved bone healing after bone flap transplantation. (2) Postoperative proximal interphalangeal joint range of motion was (55.0±14.0)°; straightening limitation was (18.5±9.0)°; excellent and good rate of total range of motion of joints was 84.6%. (3) Paired t-test results showed that there was no significant difference in proximal phalanx axial length, middle phalanx axial length, proximal interphalangeal joint surface inclination, and rotation axis deviation between the digital design group and realistic surgery group (P > 0.05). The inclination of the reconstructive finger and the joint surface of the second toe before surgery was significantly different (P < 0.05). (4) The principle of “Coadaptation” in digital design is advantageous to obtaining the best morphology and healing opportunity of reconstructed joints. By 3D printing-navigation, the digital design of morphology can be basically consistent in the actual operation, realizing the precise reconstruction of the digital joint and achieving better joint motion function.

Key words: proximal interphalangeal joint defect, toe transplantation, 3D printing, digital, coadaptation

CLC Number:

He Zaopeng1, 2, Xu Jing2, Zhang Guodong3, Wei Chunrong1, 2, Liao Xianwan1, 2, Li Wei1, 2, Huang Wenhua2 . Precise reconstruction of digital joint defect by autogenous toe joint transplantation assisted by 3D printing technology[J]. Chinese Journal of Tissue Engineering Research, 2019, 23(31): 4923-4938.

Figures/Tables 3

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