个体化截骨导板在膝关节周围截骨术中的应用研究进展

Research progress of individualized osteotomy guide plate in osteotomy around the knee

膝关节周围截骨包括胫骨近端内侧开放截骨、胫骨近端外侧闭合截骨、股骨远端外侧开放截骨、股骨远端内侧开放截骨以及双部位截骨等。截骨术通过矫正下肢力线使膝关节压力重新分布,可有效延缓膝关节骨关节炎进展。目前有三种方法用于确定术中截骨撑开的角度,包括预钻孔法、楔形填充块法和角度引导连杆法。冠状面的精准性采用髋-膝-踝角、胫骨近端内侧机械角以及下肢负重力线比率进行评估,矢状面的精准性采用胫骨后倾角进行评估。个体化截骨导板可提高截骨精准性,其制备过程包括:(1)将双下肢低剂量CT数据以DICOM格式导至重建软件,建立双下肢3D模型;(2)通过阈值分割确定截骨平面以及撑开角度,导入钢板模型,确定每个螺钉的长度以及位置;(3)基于融合沉积建模原理将混合物通过喷嘴逐层沉积材料,建立三维物体。膝关节周围截骨中使用个体化截骨导板不仅能提高手术精准性,还能降低术中透视次数和并发症发生率,手术效率及术后康复等方面均优于传统手术。膝关节周围截骨的常见并发症为术中骨折、血肿、感染。随着新材料的不断升级以及设计理念的改良,个体化截骨导板的精准度和效率将会进一步提高。未来的研究将致力于提高导板设计的个性化程度和简化制造流程。

Osteotomy around the knee includes medial opening wedge high tibial osteotomy(HTO),lateral closing wedge HTO,lateral opening wedge distal femoral osteotomy(DFO),medial opening wedge DFO,and double-site osteotomy.Osteotomy redistributes the knee joint pressure by correcting the lower limb alignment,which can effectively delay the progression of knee osteoarthritis.Currently,three methods are used to determine the intraoperative osteotomy angle:the pre-drilling method,wedge block insertion method,and angle-guided linkage method.Coronal plane accuracy is evaluated using the hip-knee-ankle(HKA)angle,medial proximal tibial angle(MPTA),and ratio of lower limb weight-bearing line,while sagittal plane accuracy is assessed by measuring the posterior tibial slope(PTS).Individualized osteotomy guide plate can enhance osteotomy accuracy.The preparation process includes:(1)importing low-dose CT data of both lower limbs in DICOM format into reconstruction software to establish a 3D model of both lower limbs;(2)determining the osteotomy plane and distraction angle through threshold segmentation,importing the plate model,and establishing the length and position of each screw;(3)using fused deposition modeling to layer materials through a nozzle to create the 3D object.Individualized osteotomy guide plate in osteotomy around the knee can not only improve the accuracy of surgery,but also reduce the intraoperative fluoroscopy times and the incidence of complications.The operation efficiency and postoperative rehabilitation are better than those of traditional surgery.With the continuous upgrading of new materials and the improvement of design concepts,the accuracy and efficiency of individualized osteotomy guide will be further improved.Future research will focus on improving the degree of personalization of guide plate design and simplifying the manufacturing process.