3D打印个体化导向器辅助膝关节置换术出现股骨前皮质切割的原因分析

王晓华; 姬晓佩; 张继晓; 袁亮; 孙彬; 刘新光; 张克; 杨滨

doi:10.16016/j.2097-0927.202112126

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3D打印个体化导向器辅助膝关节置换术出现股骨前皮质切割的原因分析

专题报道：3D打印技术在骨关节外科的临床应用 | 更新时间：2026-01-09

- 3D打印个体化导向器辅助膝关节置换术出现股骨前皮质切割的原因分析
- Anterior femoral notching in total knee arthroplasty assisted with 3D printed patient-specific instrumentation: a cause analysis
- 陆军军医大学学报 2022年44卷第15期页码：1549-1556
- 作者机构：
  
  1.102206 北京，北京大学国际医院骨科
  2.253899 河北衡水，衡水市第八人民医院骨二科
- 作者简介：
  
  [杨滨，E-mail：yangbin@pkuih.edu.cn YANG Bin, E-mail: yangbin@pkuih.edu.cn
- 基金信息：
  
  北京大学国际医院院内科研基金(YN2019ZD05);利益冲突声明本文所有作者声明不存在利益冲突
- DOI：10.16016/j.2097-0927.202112126
  中图分类号： R319;R619;R687.4
- 收稿：2021-12-15，
  
  修回：2022-04-29，
  
  纸质出版：2022-08-15
- 稿件说明：
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王晓华, 姬晓佩, 张继晓, 等. 3D打印个体化导向器辅助膝关节置换术出现股骨前皮质切割的原因分析[J]. 陆军军医大学学报, 2022,44(15):1549-1556.

Xiaohua WANG, Xiaopei JI, Jixiao ZHANG, et al. Anterior femoral notching in total knee arthroplasty assisted with 3D printed patient-specific instrumentation: a cause analysis[J]. Journal of Army Medical University, 2022, 44(15): 1549-1556.
王晓华, 姬晓佩, 张继晓, 等. 3D打印个体化导向器辅助膝关节置换术出现股骨前皮质切割的原因分析[J]. 陆军军医大学学报, 2022,44(15):1549-1556. DOI： 10.16016/j.2097-0927.202112126.

Xiaohua WANG, Xiaopei JI, Jixiao ZHANG, et al. Anterior femoral notching in total knee arthroplasty assisted with 3D printed patient-specific instrumentation: a cause analysis[J]. Journal of Army Medical University, 2022, 44(15): 1549-1556. DOI： 10.16016/j.2097-0927.202112126.

摘要

目的

采用三维立体图像分析3D打印个体化导向器辅助膝关节置换术出现股骨前皮质切割的原因。

方法

回顾性分析北京大学国际医院骨科关节组2019年1月至2021年9月连续行3D打印个体化导向器辅助全膝关节置换出现股骨前皮质切割的患者资料，分别对术中截骨后的膝关节及术中截取的骨片进行三维CT扫描，采用Rapidform软件将上述图像进行三维重建并与术前规划的三维模型进行图像配准及对比分析，测量股骨前皮质切割深度、截取骨片与术前设计的厚度差值，分析出现股骨前皮质切割的原因。

结果

共收集连续性患者86例(94膝)，出现股骨前皮质切割共17例(18膝)，发生率19.1%(18/94)。分析出现股骨前皮质切割的原因共3类: 股骨个体化导向器位置异常10例，占83.3%；术中减小股骨假体型号2例，占16.7%；股骨假体过伸位设计1例，占8.3%。

结论

股骨个体化导向器位置异常、术中减小股骨假体型号和术前股骨假体过伸位设计是导致3D打印个体化导向器辅助膝关节置换发生股骨前皮质切割的主要原因。

Abstract

Objective

To find out the causes of anterior femoral notching in 3D printed patient-specific patient-specific instrumentation (PSI) assisted total knee arthroplasty (TKA).

Methods

A retrospective analysis was carried out on the consecutive cases undergoing PSI assisted TKA in the Peking University International Hospital from January 2019 to September 2021. The clinical data of those having anterior femoral notching were collected. 3D CT scanning was performed on the knee joint after intraoperative osteotomy and the intraoperative bone fragments. Rapidform software (Version 2006) was used to reconstruct 3D images and to perform image registration and comparison analysis with the preoperatively planned 3D models. The anterior femoral notching depth was measured

and the differences in the thickness of bone fragments between preoperatively planned and intraoperative bone cutting in order to analyze the causes of the anterior femoral notching.

Results

A total of 86 consecutive cases (94 knees) were included and 17 cases (18/94

19.1%) of them had anterior femoral notching. The causes of anterior femoral notching were summarized into 3 categories: abnormal position of the PSI (10 cases

83.3%)

intraoperative reduction of the femoral prosthesis size (2 cases

16.7%)

and overextension of the femoral prosthesis (1 case

8.3%).

Conclusion

Abnormal femoral PSI position

intraoperative reduction of femoral prosthesis size

and preoperative femoral prosthesis overextension design are the main causes of anterior femoral notching after PSI assisted knee arthroplasty.

关键词

Keywords

references

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改良3D打印个体化导向器辅助全膝关节置换术的假体型号与术前规划一致性分析