CAD结合3D打印导航模板辅助TKA术前设计和临床应用  

Preoperative design and clinical application of TKA assisted by CAD combined with 3D printing navigation templates

作　　者：丁焕文[1] 苗秋菊[1,2] 刘辉亮 王虹[1] 涂强[1] 陈加荣[1] 黄敏强[1] 滕强[1] DING Huanwen;MIAO Qiuju;LIU Huiliang;WANG Hong;TU Qiang;CHEN Jiarong;HUANG Minqiang;TENG Qiang(Department of Bone and Joint Disease,Guangzhou General Hospital of Guangzhou Military Command,Guangzhou,Guangdong 510010,China)

机构地区：[1]广州军区广州总医院骨病关节科,510010 [2]广州中医药大学研究生院,510405

出　　处：《中国骨科临床与基础研究杂志》2017年第5期261-268,共8页Chinese Orthopaedic Journal of Clinical and Basic Research

基　　金：广东省科技计划项目(2012A030400024);广东省自然科学基金(2014A030310147)

摘　　要：目的探讨计算机辅助设计(CAD)结合3D打印导航模板在全膝关节置换(TKA)手术中的应用效果。方法对具有TKA手术指征的患者进行术前CT扫描、三维重建和下肢解剖参数三维测量;在三维模型上选择匹配合适型号的假体,根据患者股骨髁外形和假体匹配情况,采用CAD技术设计个性化股骨远端截骨模板、股骨远端+1 mm截骨模板、外翻+1°截骨模板、外翻-1°截骨模板、股骨远端4合1截骨模板等,并通过3D打印技术制作实物模板,以引导股骨远端精准截骨。2014年3月至2016年10月采用该新方法辅助完成16例(18膝)TKA手术(3D打印组),选取同期行传统TKA手术的16例(16膝)患者纳入常规手术组。32例患者中男18例,女14例,年龄53~85岁,平均年龄(68.1±2.3)岁。记录手术时间和术中出血量,比较两组患者假体匹配、肢体力线恢复情况和手术疗效的差异。结果 3D打印组手术时间、术中出血量均少于常规手术组,两组术后3个月美国特种外科医院(HSS)膝关节评分比较,差异有统计学意义(P<0.05)。3D打印组经术前三维规划预测的假体尺寸与实际尺寸一致,而常规手术组根据X线片二维图像预选假体型号,准确率仅为75%;3D打印组假体位置、型号匹配良好,常规手术组股骨假体悬挂1例、股骨皮质过度切割1例;两组下肢力线内外翻偏差≤3°百分比比较,差异无统计学意义(3D打印组94%vs常规手术组88%,P>0.05)。结论将CAD结合3D打印导航模板技术用于辅助TKA手术,可实现术前准确预选假体型号、术中精准截骨,方便可行,效果显著。Objective To investigate the application of total knee arthroplasty(TKA)assisted by computer-aided design(CAD)combined with 3D printing navigation templates.Methods Patients with TKA indications were recruited.CT scan was performed on each desired lower limb,and then 3D reconstruction model was generated,anatomic parameters were obtained by 3D measurements.Suitable type of prosthesis was selected based on 3D model,personalized osteotomy templates were designed with CAD technique according to the appearance of femoral condyle and situation of prosthesis matching,which including templates of distal femur,templates 1 mm-added,1 degree-added and 1 degree-decreased to valgus angle of distal femur,and four-in-one templates of distal femur.From March 2014 to October 2016,16 patients(18 knees)received primary TKA with the new methods(3D printing group),and 16 patients(16 knees)treated in the same period performed TKA through conventional surgical approach(regular surgery group).Of all the 32 patients,there was 18 men and 14 women,with the average age of(68.1±2.3)years(53 to 85 years).Operation time and intraoperative estimate blood loss were recorded,differences of prosthesis position,limb alignment and operative effects were compared between two groups.Results Operation time and intraoperative estimate blood loss in 3D printing group were lower than those in regular surgery group,also,there was statistical difference of Hospital for Special Surgery(HSS)score 3 months postoperatively between two groups(P<0.05).The accuracy of prosthesis prediction was 100%in 3D printing group and 75%in regular surgery group.In 3D printing group,prosthesis position and size were all good-matching,while in regular surgery group,there were prosthesis overhanging in 1 case and femoral cortex over-cutting in 1 case.Percentage of the limb alignment error in range of 3 degree was 94%in 3D printing group and 88%in regular surgery group,there was no significant difference between two groups(P>0.05).Conclusion For TKA operation,assistance of CAD

关 键 词：关节成形术 置换 膝 膝关节 人工 计算机辅助设计 图像处理 计算机辅助 3D打印 导航模板 外科手术 计算机辅助 

分 类 号：R687.4[医药卫生—骨科学]