3D打印个性化导航定位导板在全膝关节表面置换术中的应用

Clinical Application of Customized Osteotomy Navigator Assisted Total Knee Arthroplasty in the Treatment of Osteoarthritis by Three-dimensional Printing

目的:探讨个性化导航定位导板应用于全膝关节表面置换术中的准确性及有效性。方法:56例膝关节骨关节炎患者行全膝关节表面置换(TKA)手术,其中28例行3D+打印截骨定位导板辅助下TKA手术,28例行常规TKA手术。截骨导板组术前行下肢全长CT扫描,对所获Dicom格式数据使用Mimcs17.0软件进行三维重建获取下肢全长的三维数据,根据所得数据进行个性化截骨导板的CAD设计,再使用3D打印技术制作导板。记录两组术后髋-膝-踝角、股骨组件角、胫骨组件角等力线偏移值,同时记录手术时间、术后引流量并与常规手术组进行比较。结果:术后截骨导板组、常规手术组髋膝踝角偏差(1.2±1.1°,3.3±2.7°,P<0.05)、冠状面股骨组件角偏差(1.0±0.7°,2.3±1.2°,P<0.05)、矢状面股骨组件角偏差(0.5±0.2°,1.4±0.7°,P<0.05)、冠状面胫骨组件角偏差(1.3±1.0°,2.4±1.4S,P<0.05)、矢状面胫骨组件角偏差(3.2±1.2°,5.2±2.7°,P<0.05)均小于常规手术。结论:个性化导航定位导板可以实现更精确的TKA假体安装,提升TKA手术的精度与疗效。

Objective： To investigate the application of 3D printed customized osteotomy navigator （CON） assisted total knee arthroplasty （TKA） in the treatment of osteoarthritis （OA）. Methods： 28 patients with OA were examined using CT scanning. Anatomical data of Dicom was reconstructed to STL data through Mimcs17.0 software with customized osteotomy navigator designed from the individual anatomy. Fused deposition modeling technique was used to construct the navigators. Comparison of the two groups of the post-operative hip-knee-ankle （HKA）, frontal femoral component （FFC）, lateral femoral component （LFC）, frontal tibial component （FTC） and lateral tibial component （LTC）, time of operation, post-operative drainage volume. Results ： The average difference-value of HKA, FFC, LFC, FTC and LTC at CON procedure were lower than non-CON procedure （P〈0.05）. CON procedure has a shorter time of operation and smaller amount of post-operative wound drainage, compared to the conventional surgery group （P〈0.05）. Conclusion： Customized osteotomy navigator may help to make the TKA procedure more accurate and rapid, -which may be useful for the improvement of clinical effects.