Consolidação viciosa da fratura do rádio distal: osteotomia corretiva por meio de planejamento com prototipagem em impressão 3D
Data
2022-12-05
Autores
Alves, Bernardo Vaz Peres 
Orientadores
Belloti, João Carlos
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: As fraturas do rádio distal (FRD) estão entre as mais frequentes do corpo. Cerca de um terço dessas fraturas podem resultar em consolidação viciosa com restrição de movimentos e dor no punho, o tratamento nesses casos consiste na osteotomia corretiva da deformidade. Devido à sua complexidade tridimensional (3D), o planejamento pré-operatório cuidadoso é uma etapa fundamental na correção. A prototipagem a partir da reconstrução 3D da tomografia computadorizada (TC) do punho afetado, permite o real entendimento da deformidade. Método: Pacientes com consolidação viciosa do rádio distal com indicação de tratamento cirúrgico, a partir de dezembro de 2019, foram incluídos no grupo de osteotomias corretivas por meio de planejamento com prototipagem em impressão 3D. O resultado funcional pós-operatório foi avaliado pelo Disabilities of the Arm, Shoulder and Hand Score (DASH) e a dor pela escala visual analógica (EVA). Os dados radiográficos, incluindo inclinação radial, altura radial, inclinação volar, variância ulnar foram registrados nas incidências radiográficas posteroanterior e lateral. Nos casos com acometimento intra-articular, o degrau articular foi avaliado por TC pós-operatória. Resultados: Foram incluídos 9 pacientes. A média de idade foi de 47,5 anos. O valor médio do DASH pós-operatório dos pacientes foi 24,9 uma redução média de 36,75 (p=0,009). A dor, avaliada pela EVA, teve uma redução de 4,2 (p=0,008) comparando o pré e pós-operatório. Na avaliação radiográfica, a inclinação palmar teve uma correção média de 25,22º (p=0,011), a inclinação radial teve uma melhora média de 2º (p=0,034), altura radial teve melhora média de 1,86mm (p=0,007) e a variância ulnar teve correção média de 1,90mm (p=0,012). O degrau articular teve restauração em 2,92 mm (p=0,066). Conclusão: O estudo evidenciou melhora funcional aferida pelo questionário DASH, da dor pela EVA e dos parâmetros radiográficos comparando o pré e pós-operatório das osteotomias corretivas do radio distal, submetidas ao planejamento com prototipagem em 3D.
Introduction: Distal radius fractures (DRF) are among the most frequent in the body. About a third of these fractures can result in malunion with restriction of movement and wrist pain, the treatment in these cases consists of corrective osteotomy of the deformity. Due to its three-dimensional (3D) complexity, careful preoperative planning is a critical step in correction. Prototyping from 3D computed tomography (CT) reconstruction of the affected wrist allows a real understanding of the deformity. Methods: Patients with malunion of the distal radius with indication for surgical treatment, as of December 2019, were included in the corrective osteotomies group through planning with 3D printing prototyping. Postoperative functional outcome was assessed using the Disabilities of the Arm, Shoulder and Hand Score (DASH) and Visual Analog Scale (VAS). Radiographic data including radial tilt, radial length, volar tilt and ulnar variance were recorded on posteroanterior and lateral radiographic views. In cases with intra-articular involvement, the joint step was evaluated by postoperative CT. Results: Nine patients were included. The mean age was 47.5 years. The patients' mean postoperative DASH value was 24.9, a mean reduction of 36.75 (p=0.009). Pain, evaluated by VAS, had a reduction of 4.2 (p=0.008) comparing the pre and postoperative period. In the radiographic evaluation, the palmar inclination had an average correction of 25.22º (p=0.011), and the radial inclination had an average improvement of 2º (p=0.034), radial length had a mean improvement of 1.86mm (p=0.007) and ulnar variance had a mean correction of 1.90 mm (p=0.012). The articular step was restored at 2.92 mm (p=0,066). Conclusion: The study showed improvement in DASH and VAS and radiographic parameters comparing the pre and postoperative of corrective osteotomies of the distal radius malunion, submitted to planning with 3D prototyping.
Introduction: Distal radius fractures (DRF) are among the most frequent in the body. About a third of these fractures can result in malunion with restriction of movement and wrist pain, the treatment in these cases consists of corrective osteotomy of the deformity. Due to its three-dimensional (3D) complexity, careful preoperative planning is a critical step in correction. Prototyping from 3D computed tomography (CT) reconstruction of the affected wrist allows a real understanding of the deformity. Methods: Patients with malunion of the distal radius with indication for surgical treatment, as of December 2019, were included in the corrective osteotomies group through planning with 3D printing prototyping. Postoperative functional outcome was assessed using the Disabilities of the Arm, Shoulder and Hand Score (DASH) and Visual Analog Scale (VAS). Radiographic data including radial tilt, radial length, volar tilt and ulnar variance were recorded on posteroanterior and lateral radiographic views. In cases with intra-articular involvement, the joint step was evaluated by postoperative CT. Results: Nine patients were included. The mean age was 47.5 years. The patients' mean postoperative DASH value was 24.9, a mean reduction of 36.75 (p=0.009). Pain, evaluated by VAS, had a reduction of 4.2 (p=0.008) comparing the pre and postoperative period. In the radiographic evaluation, the palmar inclination had an average correction of 25.22º (p=0.011), and the radial inclination had an average improvement of 2º (p=0.034), radial length had a mean improvement of 1.86mm (p=0.007) and ulnar variance had a mean correction of 1.90 mm (p=0.012). The articular step was restored at 2.92 mm (p=0,066). Conclusion: The study showed improvement in DASH and VAS and radiographic parameters comparing the pre and postoperative of corrective osteotomies of the distal radius malunion, submitted to planning with 3D prototyping.
Descrição
Citação
ALVES, Bernardo Vaz Peres. Consolidação viciosa da fratura do rádio distal: osteotomia corretiva por meio de planejamento com prototipagem em impressão 3D. 2022. 88 f. Dissertação (Mestrado em Cirurgia Translacional) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP). São Paulo, 2022.