SLA激光3D打印导向器在全膝关节置换术中的应用研究

Application of SLA Laser 3D Print Guide in Total Knee Arthroplasty

目的:探究SLA激光3D打印导向器在全膝关节置换术中的临床应用价值和可行性。方法:纳入1例骨性关节炎患者,行双下肢多排双源螺CT平扫,利用计算机软件Mimics19.0进行患者DICOM处理数据,测量力线和畸形角度,重建骨骼模型:使用UG(Unigraphics)NX 11.0进行导向器设计和术前模拟手术操作;术中使用SLA激光3D打印机制造的导向器进行截骨定位,安装假体,术后复查膝关节正侧位X线片,记录术前、术后4周的美国特种外科医院(Hospitcal for Special Surgery,HSS)评分情况、膝关节活动度(range of motion,ROM)、下肢力线角度(股骨与胫骨机械轴的夹角)。结果:患者手术过程顺利,膝关节假体位置良好,关节间隙平行等宽,膝关节内翻畸形得以矫正,术后4周HSS评分74,关节活动度ROM:屈98°、伸3°下肢力线角度(股骨与胫骨机械轴的夹角):HKA角176.59°,FFC角94.63°,FTC角87.55°,LFC角13.96°,LTC角91.97°。患者恢复满意膝关节活动度和正常的下肢生物学力线。结论:SLA激光3D打印导向器应用于全膝关节置换术可简化手术操作,提高截骨精准性,获得良好的下肢力线,为TKA手术提供了一种切实可行的方法。

Objective： To explore the clinical value and feasibility of SLA laser 3D printing guide in total knee arthroplasty. Methods： One patient with osteoarthritis was enrolled in this study. Multiple double-helical CT scans of both lower extremities were performed. DICOM data were processed with conaputer software Mimics19.0 software to measure the line of force and angle of deformity. The skeletal models were reconstructed using UG （Unigraphics） NX 11.0 was used to design the guide and simulate the operation preoperatively. During operation, the guide made by SLA laser 3D printer was used for osteotomy. The prosthesis was installed. The posterior knee X- Four weeks after surgery, the score of Hospital for Special Surgery （HSS）, range of motion （ROM）, angle of tbrce of lower extremity （the angle between femur and tibial shaft） were calculated. Results： The operation procedure of the patients was smooth, the position of the knee joint prosthesis was good, the joint space was parallel and wide, the knee varus deformity was corrected. The HSS score of 4 weeks postoperatively was 74, ROM of flexion was 98° and 3° , force line angle （angle between fenmr and tibial shaft）： HKA angle 176.59°, FFC angle 94.63°, FTC angle 87.55°, LFC angle 13.96 o and LTC angle 91.97° Patient satisfaction with knee mobility and normal lower limb biology line of force. Conclusion： The application of SLA laser 3D print guide in total knee arthroplasty can simplify the operation, improve the accuracy of osteotomy and get a good lower limb force line,which provides a feasible method for TKA.