三维CT在PSI辅助初次人工膝关节表面置换术前截骨计划中的应用  

3D Computed Tomography Assist in Making the Protocol for Primary TKA Using PSI

作　　者：崔凤金 武明鑫 白印伟[1] 蔡康 付允 谢海清[1] CUI Feng-jin;WU Ming-xin;BAI Yin-wei;CAI Kang;FU Yun;XIE Hai-qing(Department of Joint Surgery,Huizhou Third People’s Hospital,Guangzhou Medical University Huizhou,Huizhou 516002,China)

机构地区：[1]广州医科大学附属惠州市第三人民医院关节外科,广东惠州516002

出　　处：《中山大学学报（医学版）》2018年第2期245-251,共7页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省卫生厅课题(A2016A604)

摘　　要：【目的】探讨借助三维CT的术前规划在个性化手术工具(PSI)辅助初次人工膝关节表面置换中的应用。【方法】54位患膝骨关节炎的患者依据随机、"双盲"的方法分为传统工具(CI)组和PSI组,每组27位患者,进行初次膝关节表面置换术。两组术前根据三维图像及截骨数据来选取假体大小。PSI组胫骨平台假体的旋转定位依据形合度匹配,并允许假体边缘在一些部位有限超出截骨面边缘。CI组术中依据传统方法进行测量和截骨。比较两组患者手术时间,调整假体大小的例次,后髁截骨量,术后X线平片情况,术后3个月、1年AKS评分。【结果】两组手术时间无统计学差异;PSI组术中无需调整假体大小;CI组有8例所用假体与术前计划不同,均小于术前依据三维CT的测量结果;CI组平均后髁截骨量大于PSI组。术后3个月PSI组患者AKS高于CI组;术后1年两组AKS评分没有统计学差异。【结论】术前薄层CT扫描结果可用于术前截骨计划,有利于正确选择股骨假体尺寸和位置。股骨和胫骨假体在一定部位有限超出截骨面边缘,不会增加术后患者不适感。使用解剖形态的胫骨假体时,可以依据最佳覆盖原则确定胫骨假体的旋转定位。【Objective】To investigate the feasibility of making the protocol with computed tomography data for total knee arthroplasty using patient-specific femoral and tibial cutting blocks.【Methods】54consecutive patients diagnosed with osteoarthritis were divided randomly into two groups.Every patients accepted3-dimentional computed tomographys can for bilateral legs before operation,the protocol were made for every patients before operation.When making the preoperative protocol,we accepted the prothesis surpass the osteotomy edge finitely,tibia prothesis rotational orientation according to the outline of the tibial osteotomy.The thickness of the posterior condyle of femur resected was as the same with the prothesis posterior condyle as possible.The patients in trial group undergone total knee arthroplasty(TKA)using patient-specific instruments(PSI)according to the preoperative protocol,while the patients in the control group undergone TKA using custom instruments(CI).The operation time,the times that the scale of the prosthesis were altered intraoperation,the mean thickness of the posterior condyle of femur resected in the operation,AKS score3months and1year after the operation were recorded and compared between the two groups.Plain film radiography after the operation were analyzed.【Results】No significant differences were found between two groups with respect to the operation time.8patients altered to a lesser prosthesis in the CI group during the operation,all in bibia contrast to no one need alteration in the PSI group.The thickness of the osteotomy on the posterior condyle of femur in the PSI group is bigger than that of CI group as a result.The AKS score of the patients in the PSI group is higher than that of CI group3months after the operation,whereas no significant difference was found1year after the operation.【Conclusion】The reconstructed image by thin layer CT can be used for preoperation protocol for TKA,which might be helpful in deciding the size of femour prosthesis;the implants can surpass th

关 键 词：人工膝关节置换术 3D打印导板 个性化手术工具 

分 类 号：R318[医药卫生—生物医学工程]