摘要
目的探讨基于3D打印技术的个性化手术导板指导全膝关节置换术中截骨的准确性。方法将2014年8月至2015年10月拟行初次单侧全膝关节置换术的20例患者随机分为两组。手术导板辅助组10例：男4例，女6例；年龄59-78岁，平均（70．9±6．69）岁；传统截骨方法组10例：男2例，女8例；年龄58-77岁，平均（69．9±6．35）岁。传统截骨方法组采用常规截骨方法的全膝关节置换术，手术导板辅助组采用个性化手术导板辅助截骨的全膝关节置换术。评估两组患者X线片上髋-膝-踝角、冠状面股骨组件角、冠状面胫骨组件角、矢状面股骨组件角、矢状面胫骨组件角与理想状态值的偏差，及手术导板辅助组术中实际的截骨量、股骨外翻角、股骨外旋角、胫骨后倾角与术前规划的差异。结果手术导板辅助组髋-膝-踝角平均偏差0．77°±0．51°、冠状面股骨组件角平均偏差0．37°±0．53°、冠状面胫骨组件角平均偏差0．11°±0．24°，均小于传统截骨方法组（分别为2．73°±1．59°、1．22°±2．53°、1．10°±1．92°），差异均有统计学意义（P均〈0．05）。手术导板辅助组矢状面股骨组件角和胫骨组件角平均偏差8．26°±0．85°、0．71°±0．77°，与传统截骨方法组（分别为9．28°±0．58°、0．72°±1．73°）比较差异均无统计学意义（P均〉0．05）。手术导板辅助组术中实际的股骨远端截骨量、胫骨平台截骨量、股骨外翻角、股骨外旋角、胫骨后倾角与术前规划数值的差异均无统计学意义（t=-2．547，3．864，0．537，-0．040，-1．290，P均〉0．05）。结论相对于全膝关节置换传统的定位截骨方法，个性化手术导板辅助截骨更精确，特别是在冠状面上髋-膝-踝角、冠状面股骨组件角、冠状面胫骨组件角的精确度更高。
Objective To study the accuracy of preoperative planning and postoperative satisfaction of prosthesis position by applying the personal surgical cutting guide （PSCG） to total knee arthroseopy （TKA） based on 313 printing technique. Methods In this randomized study, 20 patients were selected from August 2014 to October 2015, who were randomly divided into two groups. In PSCG group, 4 males and 6 females were enrolled, with a mean age of 70.9±6.69 （from 59 to 78） years. In conventional instrumentation group, 2 males and 8 females were enrolled, with a mean age of 69.9±6.35 （from 58 to 77） years. The conventional instrumentation group was treated with conventional TKA, while the PSCG group was treated with personal surgical cutting guides. Then the knee valgus angle of patients, the angle between prosthesis components on the coronal and the sagittal plane of two groups were evaluated. Subsequently the correlation of the actual osteotomy amount, the valgas angle, caster angle, external rotation angle between intra- and preoperative planning were compared in the PSCG group. Results Compared with the ideal value of each angle, the mean deviation of the hip-knee-ankle angle 0.77°±0.51°, frontal femoral component angle 0.37°±0.53° and frontal tibial component angle 0.11°±0.24° showed statistically significant difference between two groups （P 〈 0.05）. The mean deviation of the lateral femoral component angle and the lateral tibial component angle （respectively 8.26°±0.85°, 0.71 °±0.77°） were smaller than that of the conventional instrumentation group, while the differences all had no statistically significant difference （P 〉 0.05）. The actual osteotomy amount, the valgus angle, caster angle, external rotation angle correlated well between intra- and preoperative planning （t=-2.547, 3.864, 0.537, -0.040, -1.290, P 〉 0.05）. Conclusion TKA assisted by PSCG can make lower extremity alignment and accuracy of prosthesis implantation more accurate compared with conventional TKA, especially in hip-knee-ankle angle, frontal femoral component angle and frontal tibial component angle.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2016年第3期143-150,共8页
Chinese Journal of Orthopaedics
基金
贵州省卫生计生委科学技术基金项目（gzwjkj2015-1-008）
江苏省产学研联合创新资金-前瞻洼联合研究项目（BY2014070）
关键词
关节成形术
置换
膝
个性
成像
三维
Arthroplasty, replacement, knee
Individuality
Imaging, three-dimensional
