医工交互在3D打印手术导向器辅助膝关节置换术前规划中的作用  

The role and value of surgeon-engineer interaction during preoperative planning of patient-specific instrumentation assisted total knee arthroplasty

作　　者：袁亮 王晓华 孙彬 辛星[1] 刘新光[1] 张克[1,2] 姚杰[3] 杨滨[1] Yuan Liang;Wang Xiaohua;Sun Bin;Xin Xing;Liu Xinguang;Zhang Ke;Yao Jie;Yang Bin(Department of Orthopaedics,Peking University International Hospital,Beijing 102206,China;Department of Orthopaedics,Peking University Third Hospital,Beijing 100191,China;Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education,School of Biological Science and Medical Engineering,Beijing Advanced Innovation Centre for Biomedical Engineering,Beihang University,Beijing 100191,China)

机构地区：[1]北京大学国际医院骨科部,北京102206 [2]北京大学第三医院骨科,北京100191 [3]生物力学与力生物学教育部重点实验室,北京市生物医学工程高精尖创新中心,北京航空航天大学生物与医学工程学院,北京100191

出　　处：《中华骨科杂志》2023年第15期1031-1040,共10页Chinese Journal of Orthopaedics

基　　金：北京大学国际医院院内科研基金(YN2019ZD05)。

摘　　要：目的 探讨医工交互在3D打印手术导向器辅助膝关节置换术前规划中的作用.方法 回顾性分析北京大学国际医院骨科部自2018年6月至2022年8月收治的178例3D打印手术导向器辅助膝关节置换手术病例的资料,男29例、女149例;年龄(68.4±6.2)岁(范围53~86岁);左侧93膝,右侧109膝.骨关节炎171例193膝,类风湿关节炎7例9膝.膝内翻194膝,膝外翻8膝.利用术前规划方案文件资料,描述性分析从工程师交付初始规划方案开始,经过医工交互讨论和调整,直至最终由医生确定手术规划方案为止,记录手术规划方案的调整次数、调整参数种类以及相应的调整原因.结果 202膝手术规划方案的制定均经过至少一轮的医工交互讨论,117膝(57.9%)经讨论后进行了调整,1次调整者100膝(49.5%),2次调整者10膝(5.0%),3次调整者5膝(2.5%),调整最多达4次(2膝,0.9%);余85膝(42.1%)经讨论后手术医生直接同意工程师的初始规划方案.106膝(52.5%)对股骨侧参数进行了调整,57膝(28.2%)对胫骨侧参数进行了调整,其中46膝(22.8%)同时调整了股骨侧参数和胫骨侧参数.调整最多的参数为股骨后髁截骨厚度(94膝,80.3%).调整参数的主要原因为:(1)股骨髁左右径和前后径不匹配;(2)胫骨近端扭曲畸形;(3)膝关节严重屈曲挛缩畸形;(4)胫骨平台内侧或外侧存在塌陷;(5)股骨前弓畸形.结论 医工交互在个体化膝关节置换手术中具有非常重要的作用.通过良好的医工交互,医生可以更精确、立体地分析每例患者的解剖特点和病理改变,制定个体化的手术方案.Objective To investigate the significance and importance of the interaction between surgeons and engineers during the preoperative planning phase of total knee arthroplasty(TKA)when utilizing patient-specific instrumentation(PSI).Methods A retrospective review was conducted on 202 knees of PSI-assisted TKA performed on 178 patients between June 2018 and August 2022.The patients'mean age was 68.4±6.2 years,ranging from 53 to 86 years.Among the participants,there were 149 females and 29 males,93 left knees and 109 right knees.The study involved 171 patients of osteoarthritis(193 knees)and 7 patients of rheumatoid arthritis(9 knees),with 194 knees presenting varus knees and 8 knees with valgus knees.The preoperative plan documents,from the initial engineer-designed plan to the final plan approved by the surgeon,were analyzed to assess the frequency,parameters,and reasons for adjustments made during the planning process.Results The planning of the 202 PSI-assisted TKA was subjected to at least one round of surgeon-engineer interaction.Among the 202 TKA planning,117 knees(57.9%)underwent modifications after discussion,with most plans(100 knees,49.5%)being confirmed after one round of modification.Two rounds of modifications were performed on 10 knees(5.0%),and three rounds on 5 knees(2.5%).A maximum of four rounds of modifications were made on two knees(0.9%).Furthermore,in the case of the remaining 85 knees(42.1%),the surgeons promptly consented to the engineers'initial planning following the discussions.Specific adjustments were made in 106 knees(52.5%)regarding femoral parameters,57 knees(28.2%)concerning tibial parameters,and 46 knees(22.8%)requiring adjustments to both femoral and tibial parameters.Notably,the most frequently adjusted parameter was the osteotomy thickness of the posterior femoral condyles,which was modified in 94 knees(80.3%).The reasons for adjusting femoral or tibial parameters were summarized,revealing the main factors as follows:1)Discrepancy between the mediolateral and anteroposterior diam

关 键 词：关节成形术 置换 膝 精准医学 打印 三维 医工交互 手术导向器 

分 类 号：R687.4[医药卫生—骨科学]