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Handchir Mikrochir Plast Chir 2020; 52(05): 435-440
DOI: 10.1055/a-1238-2688
Übersichtsarbeit

Kahnbeinpseudarthrose: computerassistierte virtuelle Planung der Rekonstruktion

3D analysis and computer assisted reconstruction for scaphoid non-union
Ladislav Nagy
Uniklinik Balgrist, Abteilung Handchirurgie, Zürich
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Zusammenfassung

Die eigentümliche Form des Kahnbeins ist eine Herausforderung für unser räumliches Vorstellungsvermögen. Deshalb bietet gerade bei der Rekonstruktion von Kahnbeinpseudarthrosen die Computer-Unterstützung unvergleichliche Vorteile: Sie ermöglicht die Erstellung eines echten 3-dimensionalen interaktiven Modells aus CTs, das manipuliert, bearbeitet und bei Bedarf sogar physisch gedruckt werden kann. Der Vergleich mit dem gesunden Kahnbein der Gegenseite analysiert die exakte Fehlstellung und erlaubt damit die Planung einer präzis-anatomischen Wiederherstellung der Kahnbeinform. Schließlich erleichtern computergenerierte patientenspezifischen Instrumente intraoperativ die genaue Umsetzung der Planung. Dieses Vorgehen ermöglicht es, das Kahnbein wesentlich exakter als zuvor wiederherzustellen und damit auch zuverlässiger die gestörte Handgelenkskinematik zu normalisieren. Unterdessen haben wir diese Technik bei der Rekonstruktion von über 50 fehlgestellten Kahnbeinpseudarthrosen erfolgreich angewandt.

Abstract

The odd shape of the scaphoid is a challenge to our spatial sense. Computer assistance is of an unmatched value when reconstructing a non-united scaphoid: From CT data a true 3-D-model can be generated, fully interactive; thus it can be moved, manipulated and of course also printed for hands-on experience. Comparing the virtual 3-D-models of the nonunion with the healthy contralateral scaphoid, the exact amount of the deformity is calculated which allows for the planning of an anatomically precise reconstruction of the scaphoid shape. Finally, computer generated patient specific instruments will facilitate the implementation of this planning intraoperatively. This proceeding enables us to reconstruct the non-united scaphoid markedly more accurately and with this reliably normalize wrist kinematics. Meanwhile we have applied this technique successfully in more than 50 cases of scaphoid-nonunions presenting with significant deformity.

Schlüsselwörter

Kahnbein - Pseudarthrose - Computer - Analyse - Navigation

Key words

Scaphoid - nonunion - computer - analysis - navigation


Publication History

Received: 29 July 2020

Accepted: 30 July 2020

Article published online:
29 September 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

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