基于膝关节CT及下肢全长X线片设计股骨远端截骨导板的临床应用研究  

Clinical application of distal femoral patient-specific cutting guide based on knee CT and full-length X-ray film of lower extremities

作　　者：吴碧 王跃[2] 郝鹏[2] 冯均伟 WU Bi;WANG Yue;HAO Peng;FENG Junwei(Department of Orthopaedics,People's Hospital of Deyang City,Deyang Sichuan,618000,P.R.China;Department of Orthopedics,Sichuan Academy of Medical Science&Sichuan Provincial People's Hospital,Chengdu Sichuan,610072,P.R.China)

机构地区：[1]德阳市人民医院骨科,四川德阳618000 [2]四川省医学科学院•四川省人民医院骨科,成都610072

出　　处：《中国修复重建外科杂志》2021年第2期188-194,共7页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：四川省卫生和计划生育委员会2015年科技基金项目(150189)。

摘　　要：目的探讨基于膝关节CT及下肢全长X线片设计的股骨远端截骨导板在人工全膝关节置换术(total knee arthroplasty,TKA)中应用的可行性及准确性。方法以2016年7月—2017年2月拟行初次TKA的20例膝关节重度骨关节炎患者作为研究对象。男9例,女11例;年龄53~84岁,平均69.4岁。体质量指数22.1~31.0 kg/m2,平均24.8 kg/m2。术前膝关节活动度(range of motion,ROM)为(103.0±19.4)°、疼痛视觉模拟评分(VAS)为(5.4±1.3)分、美国特种外科医院(HSS)评分为(58.1±11.3)分。术前基于下肢全长正侧位X线片及膝关节CT构建膝关节三维模型,设计并制作股骨远端截骨导板,模拟手术确定股骨远端截骨厚度。比较术前设计以及术中实际股骨远端内、外侧髁截骨厚度。记录术中失血量、术后引流量及计算隐性失血量;术后3个月行膝关节ROM、VAS评分、HSS评分评估临床疗效;通过比较术前及术后1周的股骨外翻角(femoral mechanical-anatomical angle,FMAA)、股骨远端解剖外侧角(anatomical lateral distal femoral angle,aLDFA)、股骨机械轴与胫骨机械轴夹角(mechanical femoral tibial angle,mFTA)、股骨远端屈曲角(distal femoral flexion angle,DFFA)、股骨假体屈曲角(femoral prosthesis flexion angle,FPFA)、股骨假体外侧角(anatomical lateral femoral component angle,aLFC)、前翼与股骨前方皮质线夹角(α角),评估股骨远端假体冠状面及矢状面位置。结果于股骨远端截骨导板辅助下TKA均顺利完成;术前设计股骨远端内、外侧髁截骨厚度与术中实际截骨厚度差异均无统计学意义(P>0.05)。患者均获随访3个月。术后切口均Ⅰ期愈合,未出现关节周围感染、下肢深静脉血栓形成等并发症。除1例患者未行氨甲环酸治疗外,其余19例患者术中失血量为30~150 mL,平均73.2 mL;术后引流量为20~500 mL,平均154.5 mL;隐性失血量为169.2~1400.0 mL,平均643.8 mL。术后3个月ROM为(111.5±11.5)°,与术前比较差异无统计�Objective To discuss the feasibility and accuracy of distal femoral patient-specific cutting guide in total knee arthroplasty(TKA) based on knee CT and full-length X-ray film of lower extremities. Methods Between July2016 and February 2017, 20 patients with severe knee joint osteoarthritis planned to undergo primary TKA were selected as the research object. There were 9 males and 11 females;aged 53-84 years, with an average of 69.4 years. The body mass index was 22.1-31.0 kg/m2, with an average of 24.8 kg/m2. The preoperative range of motion(ROM) of the knee joint was(103.0±19.4)°, the pain visual analogue scale(VAS) score was 5.4±1.3, and the American Hospital of Special Surgery(HSS) score was 58.1±11.3. Before operation, a three-dimensional model of the knee joint was constructed based on the full-length X-ray film of lower extremities and CT of the knee joint. The distal femoral patient-specific cutting guide was designed and fabricated, and the thickness of the distal femoral osteotomy was determined by digital simulation.The thickness of the internal and external condyle of the distal femur osteotomy before operation and the actual thickness of the intraoperative osteotomy were compared. The intraoperative blood loss, postoperative drainage loss, and hidden blood loss were recorded. The ROM of knee joint, VAS score, and HSS score at 3 months after operation were recorded to evaluate effectiveness. The position of the coronal and sagittal plane of the distal femoral prosthesis were assessed by comparing the femoral mechanical-anatomical angle(FMAA), anatomical lateral distal femoral angle(aLDFA),mechanical femoral tibial angle(mFTA), distal femoral flexion angle(DFFA), femoral prosthesis flexion angle(FPFA),anatomical lateral femoral component angle(aLFC), and the angle of the femoral component and femoral shaft(α angle)between pre-and post-operation. Results TKA was successfully completed with the aid of the distal femoral patientspecific cutting guide. There was no significant difference between the th

关 键 词：个体化截骨导板 下肢全长X线片 CT 股骨截骨 人工全膝关节置换术 

分 类 号：R687.4[医药卫生—骨科学]