三维术前计划较二维模板测量更精确拟定人工膝关节置换假体型号

三维术前较二维测量更精确拟定人工膝关节置换假体型号 许  杰，李  登，张应彬，黄玉麟，蔡志清，马若凡(中山大学孙逸仙纪念医院关节外科，广东省广州市  510120) 引用本文：许杰，李登，张应彬，黄玉麟，蔡志清，马若凡. 三维术前计划较二维模板测量更精确拟定人工膝关节置换假体型号[J].中国组织工程研究，2016，20(35):5173-5179. DOI: 10.3969/j.issn.2095-4344.2016.35.001    ORCID: 0000-0002-7515-0164(许杰) 文章快速阅读： 二维及三维术前计划在人工膝关节置换假体型号拟定中的精确性比较 许杰，男，1975年生，广东省广州市人，汉族，博士，副教授，副主任医师，主要从事骨关节外科方面的研究。 中图分类号:R318 文献标识码:A 文章编号:2095-4344 (2016)35-05173-07 稿件接受：2016-06-04 文题释义：3D打印技术：通过采集术前 CT、X射线等影像数据，经过 CAD 计算机软件处理，输入快速成型机器，制成实体硬组织一致的模型，有助于术前准确了解硬组织的细微解剖结构及病变与周围结构的关系，提示截骨线、骨块移动的位置信息等，起到指导手术的作用。全膝关节置换术前计划：术前个体化地确定假体大小，以便术中解剖测量及假体选择/截骨考量时有所参照，减少截骨失误或假体选择失当的可能；获取解剖结构信息，缩短术中测量比对时间；因应解剖结构的特殊性，个体化的订制/准备特殊尺寸假体。摘要背景：依据病例的解剖结构选择合适的假体及大小型号，同时把握截骨角度方向及截骨厚度是关节置换手术的重要环节，这有赖于精确的术前计划。目的：对比基于二维影像的传统术前模板测量与三维术前计划(三维虚拟影像测量及快速三维打印模型实物测量、模拟手术)在人工膝关节置换假体型号拟定中的精确性差异，探讨三维术前计划的参考价值。 方法：随机选择25例行初次全膝关节置换患者，其中男10例，女15例，年龄58-79岁，均完成二维及三维影像资料采集，进行二维影像模板测量与三维术前计划(针对三维虚拟成像、快速三维打印模型模拟截骨及假体置入操作)，分别拟定假体采用型号，膝关节置换中评估术前计划选择的假体型号与实际所需的一致性。结果与结论：三维术前计划对股骨侧及胫骨侧假体型号拟定的一致率分别为80%、72%，二维计划对股骨侧及胫骨侧假体型号拟定的一致率分别为4%、12%，两组股骨侧及胫骨侧假体型号拟定的一致率比较差异有显著性意义(P < 0.05)。Kappa系数统计显示，三维术前计划的假体型号拟定吻合度较好。结果表明，三维术前计划较传统二维模板测量能更精确地拟定假体型号，提供更全面的骨骼解剖资料。关键词：骨科植入物；人工假体；膝关节；全膝关节置换；假体尺寸；三维；计算机辅助设计 主题词：假体和植入物；关节成形术，置换，膝；计算机辅助设计；组织工程基金资助： 广东省科技计划项目(2014A020215009) Accuracy of analog two-dimensional and digital three-dimensional preoperative templating for predicting implant size in total knee arthroplasty Xu Jie, Li Deng, Zhang Ying-bin, Huang Yu-lin, Cai Zhi-qing, Ma Ruo-fan (Department of Joint Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, Guangdong Province, China) Abstract BACKGROUND: It is the key point to choose the right size of the prosthesis, and grasp the direction and thickness for osteotomy during total knee arthroplasty. In order to achieve the goal, accurate preoperative planning is very important. OBJECTIVE: To compare the accuracy of preoperative templating in total knee arthroplasty using conventional two-dimensional (2D) and computed tomography (CT)-based three-dimensional (3D) procedures (templating on 3D image & surgical rehearsing on rapid prototype technology-models), and to confirm the necessity of 3D evaluation for preoperative planning. METHODS: A total of 25 patients undergoing primary total knee arthroplasty were randomly selected, including 10 males and 15 females, at the age of 58 and 79 years old. 2D and 3D images were collected from all patients. Preoperative templating was performed for each total knee arthroplasty using both conventional 2D radiographs and a CT-based 3D image model. Accuracies with regard to the predicted and actual implant sizes were determined for each procedure.  RESULTS AND CONCLUSION：The 3D procedure was found to be more accurate in predicting implant size of 80% femoral and 72% tibial components than those of the 2D procedure (4% femoral and 12% tibial components). Significant differences in the consistent rate of femoral and tibial prosthesis models were detected significantly (P < 0.05). Kappa coefficient statistics demonstrated that goodness of fit of prosthesis model was good in 3D preoperative templating. Results confirmed that the superiority of 3D preoperative templating over 2D conventional evaluation is in predicting implant size, and provides more comprehensive information on skeletal anatomy. Subject headings: Prostheses and Implants; Arthroplasty, Replacement, Knee; Computer-Aided Design; Tissue Engineering Funding: the Science and Technology Plan Program of Guangdong Province, No. 2014A020215009 Cite this article: Xu J, Li D, Zhang YB, Huang YL, Cai ZQ, Ma RF. Accuracy of analog two-dimensional and digital three-dimensional preoperative templating for predicting implant size in total knee arthroplasty. Zhongguo Zuzhi Gongcheng Yanjiu. 2016;20(35):5173-5179. Xu Jie, M.D., Associate professor, Associate chief physician, Department of Joint Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, Guangdong Province, China 0  引言  Introduction 人工全膝关节置换(total knee arthroplasty，TKA)作为严重膝关节疾病的有效治疗之一，已在中国各大中城市医院广泛开展。解剖匹配的假体置入后在运动功能上更符合人体正常膝关节运动的需要，提高全膝关节置换的整体临床疗效，减少术后并发症，降低翻修率。获得病例的解剖结构数据，并据此选择合适的假体及大小型号，同时把握截骨角度方向及截骨厚度，是手术的重要环节。 术中模块测量为术者对假体的型号选择提供参考，但如术中发现准备的假体与膝关节形态不匹配，常因重新消毒需时而无法更换其他类型假体，由此被迫过度切割、增加截骨或接受假体悬突来迁就，增加了术后并发症。其次受软组织覆盖、术野暴露所限，术中精确测量假体大小有时也存在困难[1]。有鉴于此，不同研究机构均着眼于完善术前计划的研究[2-5]。研究表明，目前常用的基于二维X射线术前平片所进行模板测量的方法，并不能准确预测术中所需假体的大小[6-8]，甚至对下肢力线的确定也存在偏差[9]。