改良3D打印个体化导向器辅助全膝关节置换术的假体型号与术前规划一致性分析

Planned prosthesis size in modified 3D printed patient-specific instrumentation-assisted total knee arthroplasty:analysis of consistency with intraoperative size

目的通过对比术中使用假体型号与术前三维规划假体型号的差异,探讨改良3D打印个体化导向器辅助人工全膝关节置换术的假体型号与术前规划的一致性。方法北京大学国际医院骨科对传统3D打印个体化导向器辅助人工全膝关节置换术的工作流程、设计方案、导向器形态、操作技术、验证方法等均进行优化改良。回顾性分析接受基于术前CT设计的3D打印个体化截骨导向器辅助全膝关节置换术126例(137膝)临床资料,对比分析术中实际使用的假体型号与术前规划型号的差异。结果所有患者顺利接受手术,无严重并发症发生。股骨侧假体:术中实际使用型号与经过医师调整后术前规划假体型号有差异的7例,但差异无统计学意义。术中实际使用型号与工程师初始设计方案有差异的25例,差异有统计学意义(P<0.01),经过医师调整的工程师初始设计方案为19例,差异有统计学意义(P<0.01)。胫骨侧假体:术中实际使用型号与经过医师调整后术前规划假体型号有差异的39例,术中实际使用型号与工程师初始设计方案有差异的44例,经过医师调整的工程师初始设计方案为5例,但差异无统计学意义。结论改良3D打印个体化导向器辅助人工全膝关节置换术的假体型号与术前规划一致性较好,经医师调整后的一致性更高。

Objective To explore the prediction accuracy of prosthesis size of the modified 3 D printed patient-specific instrumentation(PSI)-assisted total knee arthroplasty(TKA)by comparing the difference between intraoperative prosthesis size and preoperative planned prosthesis size.Methods We optimized and improved the workflow,design scheme,shape of guide,operation technology and verification method of the traditional PSI-assisted TKA.A total of 126 patients(137 knees)who received 3 D printed PSI-assisted TKA based on preoperative CT images in our center were recruited in this study.The differences between the actual prosthesis size and the preoperative planned size were compared and analyzed.Results All patients completed the surgery successfully,and no serious complications occurred.For the femoral side,the difference between the actual used size and the doctor’s planned size was observed in 7 cases,and the difference between the actual used size and the engineer’s planned size was in 25 cases(P<0.01),and the engineer’s planned size adjusted by doctors was 19 cases(P<0.01).For the tibial side,the actual used size and the doctor’s planned size was 39 cases,the difference between the actual used size and the engineer’s planned size was 44 cases,and the engineer’s planned size adjusted by doctors was 5 cases.Conclusion The planned prosthesis size in Our modified 3 D printed PSI-assisted TKA is consistent with the intraoperative prosthesis size,and the plan will be more consistent after adjustment by the doctors.