CT结合双下肢负重位力线X线影像制作3D打印个性化模具辅助行膝关节置换术临床研究  

Total knee arthroplasty using 3D printing individualized osteotomy mold by CT combined with X-ray in lower limbs mechanical alignment

作　　者：孙保飞 刘欣伟[1] 张敬东[1] 何勇[1] 王宁[1] 韩文锋[1] SUN Bao-fei LIU Xin-wei ZHANG Jing-dong HE Yong WANG Ning HAN Wen-feng(Department of Orthopedics ,The General Hospital of Shenyang Military Command,Shenyang 110016, China)

机构地区：[1]沈阳军区总医院骨科全军重症战创伤救治中心,辽宁沈阳110016

出　　处：《临床军医杂志》2016年第10期1006-1009,共4页Clinical Journal of Medical Officers

基　　金：辽宁省科学技术计划项目面上项目(2015020446)

摘　　要：目的探讨膝关节CT结合双下肢负重位力线X线影像制作3D打印个性化模具在全膝关节置换术(TKA)精确截骨中的应用价值。方法选取自2014年4月至2016年6月沈阳军区总医院骨科收治的须行TKA患者32例,随机分为3D打印TKA组(20膝)和常规TKA组(19膝)各16例。3D打印TKA组应用膝关节CT结合双下肢负重位力线X线影像制作3D打印个性化模具辅助行TKA;对照组应用常规截骨器械行TKA。记录两组患者完成股骨及胫骨截骨所用的时间、所得胫骨侧截骨片厚度与术前规划之间的偏差以及两组患者的手术时间。结果 3D打印TKA组股骨及胫骨截骨的完成时间为(27.8±4.3)min,常规TKA组为(36.5±6.2)min,两组比较,差异有统计学意义(t=31.752,P<0.05)。3D打印TKA组胫骨侧截骨厚度与术前规划厚度偏差为(1.60±0.67)mm,常规TKA组为(3.40±1.35)mm,两组比较,差异有统计学意义(t=23.247,P<0.05);3D打印TKA组手术时间为(57.0±7.3)min,常规TKA组为(58.0±8.0)min,两组比较,差异无统计学意义(t=0.961,P>0.05)。两组患者均未出现并发症。结论应用膝关节CT结合双下肢负重位力线X线影像制作3D打印个性化模具辅助行TKA能缩短股骨及胫骨截骨所需时间,使胫骨侧截骨更加精确,但对整个TKA所需时间无明显改善。Objective To explore the efficacy of total knee arthroplasty（ TKA） with 3D printing individualized osteotomy mold using CT combined with X-ray in lower limbs mechanical alignment. Methods A retrospective study was performed on 32 patients underwent primary unilateral TKA were received in The General Hospital of Shenyang Military Command from April 2014 to June 2016. Patients were randomly divided into 3D printing TKA group（ 20 knees） using 3D printing individualized osteotomy mold by CT combined with X-ray in lower limbs mechanical alignment,conventional TKA group（ 19 knees） using osteotomy instrumentation to perform conventional TKA,with 16 cases in each group. Two groups of patients with femoral and tibial osteotomy were recorded; the deviation of the thickness of the tibial side section,the preoperative planning and the time of the operation of the two groups were recorded.Results Time of femoral and tibial osteotomy in 3D printing TKA group was（ 27. 8 ± 4. 3） minutes,time in conventional TKA group was（ 36. 5 ± 6. 2） minutes,there were statistically significant differences between the two groups（ t = 31. 752,P〈0. 05）. The deviation thickness of tibial osteotomy and preoperative planning in 3D printing TKA group was（ 1. 60 ± 0. 67） mm,in conventional TKA group was（ 3. 40 ± 1. 35） mm,there were statistically significant differences between the two groups（ t = 23. 247,P〈0. 05）. The operation time in 3D printing TKA group was（ 57. 0 ± 7. 3） minutes,in conventional TKA group was（ 58. 0 ± 8. 0） minutes,there was no significant difference between the two groups（ t = 0. 961,P〉0. 05）. There was no complication in the two groups. Conclusion Total knee arthroplasty using 3D printing individualized osteotomy mold by CT combined with X-ray in lower limbs mechanical alignment can shorten the time required for the femoral and tibial osteotomy,the tibial osteotomy is more accurate without obvious improvement in the entire TKA operation time.

关 键 词：3D打印 全膝关节置换 下肢负重位力线 

分 类 号：R687.4[医药卫生—骨科学]