Skeletální traumatologie prošla ve světě v poslední dekádě revolučními změnami v souvislosti s rozvojem technologií 3D tisku. Tento přehledový článek má za cíl přinést ucelený přehled o tom, jakým způsobem 3D tisk transformuje oblast léčby zlomenin a otevírá nové možnosti v řešení komplexních zlomenin. Využití 3D tisku v medicíně nabízí nový rozměr v přesnosti a individualizaci léčby, umožňuje vytváření personalizovaných chirurgických šablon, individualizovaných implantátů a nástrojů. Rozvoj 3D tisku je úzce propojen s dalšími technologickými pokroky, jako jsou metody augmentované reality, což představuje významný krok vpřed ve vizualizaci a plánování chirurgických zákroků. Přestože 3D aditivní technologie nabízí řadu výhod, její začlenění do běžné klinické praxe stále čelí mnoha výzvám. Tento článek rovněž zkoumá historii a vývoj technologie 3D tisku, materiály používané v medicíně, předoperační plánování, tvorbu chirurgických cíličů, výrobu pacient specifických implantátů a integraci této technologie spolu s metodami augmentované reality ve skeletální chirurgii, přičemž zdůrazňuje technické, logistické a etické výzvy při implementaci této technologie do chirurgické praxe.
The field of skeletal traumatology has undergone revolutionary changes worldwide over the last decade with the development of 3D printing technologies. This review aims to provide a comprehensive overview of how 3D printing is transforming fracture treatment and opening up new possibilities in the management of complex fractures. The use of 3D printing in medicine offers a new dimension in precision and customisation of treatment, enabling the creation of personalised surgical templates, individualised implants and tools. The development of 3D printing is closely linked to other technological advances, such as augmented reality methods, which represent a significant step forward in the visualisation and planning of surgical procedures. Although 3D printing offers many advantages, its integration into routine clinical practice still faces many challenges. This article examines the history and development of 3D printing technology, materials used in medicine, preoperative planning, the creation of surgical guides, the fabrication of patient-specific implants, and the integration of 3D printing and augmented reality in skeletal surgery, highlighting the technical, logistical, and ethical challenges of implementing this technology in surgical practice.
- MeSH
- 3D tisk * trendy MeSH
- biokompatibilní materiály MeSH
- design s pomocí počítače MeSH
- fraktury kostí * terapie MeSH
- kostní náhrady MeSH
- lidé MeSH
- traumatologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
PURPOSE OF THE STUDY: This manuscript aims to present the method of arthroscopic assisted subtalar arthrodesis and to evaluate the benefi ts of this surgery on our study population. MATERIAL AND METHODS: In the period from 9/2007 to 1/2020, a total of 33 subtalar arthrodesis were performed in 31 patients aged 19-66 years (mean 48 years, median 50 years). The indication for arthrodesis was subtalar arthritis causing pain and gait disorders, or hindfoot deformities (most commonly after a calcaneus bone fracture). The arthroscopic assisted subtalar arthrodesis was performed with autologous tricortical bone block graft harvesting from the pelvis, supplemented by autologous cancellous bone graft. Stabilization was achieved by cannulated screws inserted in neutral ankle position. Patients in our retrospective study were followed up for a mean of 48 months (range, 24-130 months). The patients were evaluated preoperatively and at 2 years after surgery. The hindfoot angles and height (TCA - talocalcaneal angle, CIA - calcaneal inclination angle, TCH - talocalcaneal height) were evaluated on radiographs, bone union was assessed on radiographs and CT scans. The clinical assessment was performed using the ankle-hindfoot scale (AHS) of AOFAS (AOFAS score). RESULTS: The preoperative AOFAS score was 35-68 points (mean 52, median 54), the postoperative AOFAS score at 2 years after arthrodesis was 58-94 points (mean 82, median 82). Both the mean and median values of AOFAS score showed a signifi - cant progress from the poor result to the good and excellent result. After 2 years the TCA value decreased in 18 patients (56%) by no more than 3°. The CIA decrease observed in 21 patients (64%) was by 1° on average. The TCH decrease of 1-5 mm after 2 years since the surgery was seen in 16 patients. In 2 patients incomplete healing of arthrodesis was observed, manifested as a clinically asymptomatic non-union. No deep infection was reported. DISCUSSION: In agreement with the current literature, the arthroscopic subtalar arthrodesis has been confi rmed to be a safe method for the management of consequences of hindfoot fractures, with minimum complications and leading to accelerated bone fusion. Differences can be found in the approach, position, use of cancellous bone graft and surgical techniques. In recent years, prone position, posterior approaches, use of cancellous bone graft, distraction and fi xation with 2-3 screws divergently inserted into the bone prevail. The degree of healing of the bone fusion is generally an important factor. In our study population, non-healing was recorded in 2 patients, namely in the form of a clinically silent non-union. Neurological or early complications and/or osteosynthesis material failure occurred in up to a maximum of 10% of cases. The conclusive results of minimally invasive arthrodesis based on the AOFAS score have been confi rmed by us as well as by most authors. CONCLUSSIONS: Our study confi rmed that the arthroscopic assisted subtalar arthrodesis is a successful, reliable and safe minimally invasive method, with minimum complications, leading to stable arthrodesis. KEY WORDS: subtalar arthrodesis, subtalar arthroscopy.
- MeSH
- artrodéza MeSH
- dolní končetina MeSH
- fraktury kostí * MeSH
- lidé MeSH
- noha (od hlezna dolů) MeSH
- patní kost * chirurgie MeSH
- poranění kotníku * MeSH
- retrospektivní studie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
