个性化股骨远端截骨导向器与传统手术工具在全膝关节置换术中的对比研究  

Comparison of patient-specific distal femoral cutting guide and conventional instruments in total knee arthroplasty

作　　者：刘浩[1] 吴博[1] 郑清源 彭海文[1] 倪明[1] 张国强[1] Liu Hao;Wu Bo;Zheng Qingyuan;Peng Haiwen;Ni Ming;Zhang Guoqiang(Department of Orthopaedics,General Hospital of PLA,Beijing 100853,China)

机构地区：[1]解放军总医院骨科,北京100853

出　　处：《中华骨科杂志》2018年第19期1170-1176,共7页Chinese Journal of Orthopaedics

基　　金：首都市民健康项目培育（Z141100002114024）

摘　　要：目的 利用快速成型及3D打印技术设计出应用于全膝关节置换术的个性化股骨远端截骨导向器,并与传统手术工具进行对比。方法 选取2015年3月至2015年11月,拟行双侧全膝关节置换术的32例患者进行前瞻性自身对照研究,两侧膝关节随机分成个性化截骨器组与传统手术组。个性化截骨器组术前获取下肢CT数据,利用快速成型及3D打印技术设计并制作个性化股骨远端截骨导向器。传统手术组应用常规器械。记录两组的手术时间,股骨远端截骨量,评估术后力线,包括下肢机械轴夹角（hip-knee-ankle angle, HKA）及股骨远端机械轴外侧角（mechanical lateral distal femoral angle, mLDFA）、胫骨近端机械轴内侧角（mechanical medial proximal tibial angle, mMPTA）;术后6周、3个月及1年随访,记录膝关节特种外科医院（Hospital for Specific Surgery,HSS）评分。结果 在冠状位上,个性化截骨器组术后mLDFA为90.34°±1.6°,传统手术组为91.37°±1.8°,两组之间差异有统计学意义（t=-2.452,P=0.020）;个性化截骨器组术后HKA角为0.36°±2.35°,传统手术组为0.87°±1.85°,两组之间差异有统计学意义（t=-2.332,P=0.043）。当术前mLDFA≤ 93°时,两组术后mLDFA无明显差异（t=-1.409, P〉0.05）;而当术前mLDFA〉93°时,两组术后mLDFA有明显差异（t=-4.145,P=0.004）。此外,个性化截骨器组手术时间明显缩短（t=-2.425,P〈0.05）,但两组在术后早期功能上并没有明显差异。结论 3D打印的个性化股骨远端截骨导向器可以明显缩短手术时间,改善术后假体力线,而且操作简单;但仍需大样本量、长时间的随访研究来验证其远期效果。Objective To design a patient-specific distal femoral cutting guide for total knee arthroplasty using rapid prototyping and 3D printing technology and compare with conventional instrumentation. Methods A prospective self-control study was performed in 32 patients who underwent bilateral total knee arthroplasty between March 2015 and November 2015 in our department. The bilateral knee joints were randomly divided into patient-specific guide group and traditional surgery group. The patient-specific guide group obtained CT data of the lower extremities preoperatively. Patient-specific distal femoral cutting guides were designed and manufactured using rapid prototyping and 3D printing techniques. The traditional surgery group were performed using conventional instrumentation. The operation time of the two groups was recorded, and the amount of distal femoral osteotomy was measured. Postoperative alignments were measured including the angle of the lower limb mechanical axis angle （hip-knee-ankle Angle, HKA）, the mechanical lateral distal femoral angle （mLDFA）, and the mechanical proximal tibial angle （mMPTA）. In different follow-up points Hospital for Specific Surgery scores of the knee were recorded. Results In the coronal position, the postoperative mLDFA was 90.34°±1.6° in the patient-specific guide group and 91.37°±1.8° in the conventional surgery group. The difference between the two groups was statistically significant （t=-2.452, P=0.020）. In the patient-specific guide group, the HKA angle was 0.36°±2.35°, and the conventional surgery group was 0.87°±1.85°. The difference between the two groups was statistically significant （t=-2.332, P=0.043）. If preoperative mLDFA≤93°, there was no significant difference in postoperative mLDFA between the two groups （t=-1.409, P〉0.05）. If preoperative mLDFA〉93°, there was a significant difference in postoperative mLDFA between the two groups （t=-4.145, P=0.004）. In addition, the operation time of the patient-specific guide group

关 键 词：关节成形术 置换 膝 截骨术 成像 三维 

分 类 号：R687.4[医药卫生—骨科学]