膝关节假体置换发展及数字化成型技术的应用

Development of knee prosthesis replacement and application of digital molding technology

背景:随着膝关节假体材料及生物力学研究的不断深入,假体设计不断更新。如何提高假体置入的几何精度,重建生物学意义上的膝关节,一直是临床关注的核心问题。目的:总结不同膝关节假体的临床应用概况,探索膝关节三维重建个体化方案,为人工膝关节假体的设计及置换提供良好的生物力学基础。方法:电子检索CNKI数据库、万方数据库中收录的膝关节假体设计,人工膝关节置换及数字化成型技术在人工膝关节设计中应用的相关综述、实验研究及临床论著,排除陈旧文献及置换方式保守治疗患者资料。结果与结论:共纳入相关文献27篇。随着人们对膝关节生物力学和解剖的进一步理解,患者对人工膝关节的功能有进一步的要求,数字化重建技术为膝关节几何测量及置换的精准度提供新的思路和技术方法,为胫骨假体形态设计提供解剖数据,提高假体和截面适配度及关节稳定性,减少假体松动等并发症的发生,延长假体使用寿命。基于影像数据进行膝关节三维重建方案可行,效果肯定,可清晰、直观、多角度的观察膝关节的形态特点,既可作为骨关节局部解剖的教学方法又为临床应用提供可靠数据。

BACKGROUND： With the further studies of the materials and biomechanics of knee prosthesis, prosthesis design is constantly updated. How to improve the geometric accuracy of prosthesis and to reconstruct the biologically functiona knee joint are the key issues in clinic. OBJECTIVE： To summarize the clinical application of different knee prostheses, and to explore individualized program for three-dimensional （3D） reconstruction of knee joints, which provides a biomechanical foundation for design and replacement of artificial knee prosthesis. METHODS： An online retrieval of CNKI and Wanfang databases was conducted by reviews for experimental researches related reviews and clinical originals related to the preparation and design of knee prosthesis, artificial knee replacement and the application of digital modeling technology for knee prosthesis design. Old documents and information about the patients treated with conservative treatment were excluded. RESULTS AND CONCLUSION： A total of 27 documents were involved. The further understanding of biomechanics and anatomy of knee joint causes more requirements of patients for the function of knee prosthesis. Digital technology for knee reconstruction provides a new idea and technical method for the accuracy of knee joint geometric measurements and replacement, provide anatomical data for tibial prosthesis design, in a broader attempt to improve the adaption between the prosthesis and the cross section, as well as the joint stability, and reduces the loosening and other complications, and extends the life of the prosthesis. The image-based project is a feasible approach for the 3D knee reconstruction; it can clearly and intuitively conduct multi-angle observations of morphological characteristics of knee joints, thus serving as a teaching method for local anatomy of joints and providing reliable data for clinical application.