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

孙彬; 张继晓; 袁亮; 王晓华; 张克; 姚杰; 杨滨

doi:10.16016/j.2097-0927.202202034

您当前的位置：

首页 >

文章列表页 >

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

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

- 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
- Planned prosthesis size in modified 3D printed patient-specific instrumentation-assisted total knee arthroplasty: analysis of consistency with intraoperative size
- 陆军军医大学学报 2022年44卷第15期页码：1523-1530
- 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
  3.100191 北京，北京航空航天大学生物医学工程高级创新中心生物科学与医学工程学院，生物力学与机械生物学教育部重点实验室
- 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与关节假体厂家无相关利益冲突
- DOI：10.16016/j.2097-0927.202202034
  中图分类号： R181.32;R319;R687.4
- 收稿：2022-02-15，
  
  修回：2022-05-19，
  
  纸质出版：2022-08-15
- 稿件说明：
移动端阅览
孙彬, 张继晓, 袁亮, 等. 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[J]. 陆军军医大学学报, 2022,44(15):1523-1530.

Bin SUN, Jixiao ZHANG, Liang YUAN, et al. Planned prosthesis size in modified 3D printed patient-specific instrumentation-assisted total knee arthroplasty: analysis of consistency with intraoperative size[J]. Journal of Army Medical University, 2022, 44(15): 1523-1530.
孙彬, 张继晓, 袁亮, 等. 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[J]. 陆军军医大学学报, 2022,44(15):1523-1530. DOI： 10.16016/j.2097-0927.202202034.

Bin SUN, Jixiao ZHANG, Liang YUAN, et al. Planned prosthesis size in modified 3D printed patient-specific instrumentation-assisted total knee arthroplasty: analysis of consistency with intraoperative size[J]. Journal of Army Medical University, 2022, 44(15): 1523-1530. DOI： 10.16016/j.2097-0927.202202034.

摘要

目的

通过对比术中使用假体型号与术前三维规划假体型号的差异，探讨改良3D打印个体化导向器辅助人工全膝关节置换术的假体型号与术前规划的一致性。

方法

北京大学国际医院骨科对传统3D打印个体化导向器辅助人工全膝关节置换术的工作流程、设计方案、导向器形态、操作技术、验证方法等均进行优化改良。回顾性分析接受基于术前CT设计的3D打印个体化截骨导向器辅助全膝关节置换术126例(137膝)临床资料，对比分析术中实际使用的假体型号与术前规划型号的差异。

结果

所有患者顺利接受手术，无严重并发症发生。股骨侧假体: 术中实际使用型号与经过医师调整后术前规划假体型号有差异的7例，但差异无统计学意义。术中实际使用型号与工程师初始设计方案有差异的25例，差异有统计学意义(

0.01)，经过医师调整的工程师初始设计方案为19例，差异有统计学意义(

0.01)。胫骨侧假体: 术中实际使用型号与经过医师调整后术前规划假体型号有差异的39例，术中实际使用型号与工程师初始设计方案有差异的44例，经过医师调整的工程师初始设计方案为5例，但差异无统计学意义。

结论

改良3D打印个体化导向器辅助人工全膝关节置换术的假体型号与术前规划一致性较好，经医师调整后的一致性更高。

Abstract

Objective

To explore the prediction accuracy of prosthesis size of the modified 3D printed patient-specific instrumentation (PSI)-assisted total knee arthroplasty (TKA) by comparing the difference between intraoperative prosthesis size and preoperative planned prosthesis size.

Methods

We optimized and improved the workflow

design scheme

shape of guide

operation technology and verification method of the traditional PSI-assisted TKA. A total of 126 patients (137 knees) who received 3D printed PSI-assisted TKA based on preoperative CT images in our center were recruited in this study. The differences between the actual prosthesis size and the preoperative planned size were compared and analyzed.

Results

All patients completed the surg

ery successfully

and no serious complications occurred. For the femoral side

the difference between the actual used size and the doctor's planned size was observed in 7 cases

and the difference between the actual used size and the engineer's planned size was in 25 cases (

0.01)

and the engineer's planned size adjusted by doctors was 19 cases (

0.01). For the tibial side

the actual used size and the doctor's planned size was 39 cases

the difference between the actual used size and the engineer's planned size was 44 cases

and the engineer's planned size adjusted by doctors was 5 cases.

Conclusion

The planned prosthesis size in Our modified 3D printed PSI-assisted TKA is consistent with the intraoperative prosthesis size

and the plan will be more consistent after adjustment by the doctors.

关键词

Keywords

references

BERGER R A, ROSENBERG A G, BARDEN R M, et al . Long-term followup of the Miller-Galante total knee replacement[J ] . Clin Orthop Relat Res, 2001(388): 58-67. DOI: 10.1097/00003086-200107000-00010.

INSALL J N, BINAZZI R, SOUDRY M, et al . Total knee arthroplasty[J ] . Clin Orthop Relat Res, 1985, 192: 13-22. DOI: 10.1097/00003086-198501000-00003.

RITTER M A, KEATING E M, SUEYOSHI T, et al . Twenty-five-years and greater, results after nonmodular cemented total knee arthroplasty[J ] . J Arthroplasty, 2016, 31(10): 2199-2202. DOI: 10.1016/j.arth.2016.01.043.

ARNHOLT C M, MACDONALD D W, MALKANI A L, et al . Corrosion damage and wear mechanisms in long-term retrieved CoCr femoral components for total knee arthroplasty[J ] . J Arthroplasty, 2016, 31(12): 2900-2906. DOI: 10.1016/j.arth.2016.05.006.

杨滨, 袁亮, 张克, 等. 新型改良3D打印个体化导向器辅助全膝关节置换术的精准度研究[J]. 中华骨科杂志, 2021, 41(2): 67-75. DOI: 10.3760/cma.j.cn121113-20200715-00451.

YANG B, YUAN L, ZHANG K, et al . The accuracy of bony resection and component size planning of total knee arthroplasty assisted with a novel designed patient-specific instrumentation[J ] . Chin J Orthop, 2021, 41(2): 67-75. DOI: 10.3760/cma.j.cn121113-20200715-00451.

NOBLE J W Jr, MOORE C A,LIU N. The value of patient-matched instrumentation in total knee arthroplasty[J]. J Arthroplasty, 2012, 27(1): 153-155. DOI: 10.1016/j.arth.2011.07.006.

PIETSCH M, DJAHANI O, ZWEIGER C, et al . Custom-fit minimally invasive total knee arthroplasty: effect on blood loss and early clinical outcomes[J ] . Knee Surg Sports Traumatol Arthrosc, 2013, 21(10): 2234-2240. DOI: 10.1007/s00167-012-2284-z.

CUCCHI D, MENON A, COMPAGNONI R, et al . Significant differences between manufacturer and surgeon in the accuracy of final component size prediction with CT-based patient-specific instrumentation for total knee arthroplasty[J ] . Knee Surg Sports Traumatol Arthrosc, 2018, 26(11): 3317-3324. DOI: 10.1007/s00167-018-4876-8.

ISSA K, RIFAI A, MCGRATH M S, et al . Reliability of templating with patient-specific instrumentation in total knee arthroplasty[J ] . J Knee Surg, 2013, 26(6): 429-433. DOI: 10.1055/s-0033-1343615.

SCHOTANUS M G M, SCHOENMAKERS D A L, SOLLIE R, et al . Patient-specific instruments for total knee arthroplasty can accurately predict the component size as used peroperative[J ] . Knee Surg Sports Traumatol Arthrosc, 2017, 25(12): 3844-3848. DOI: 10.1007/s00167-016-4345-1.

GONG S, XU W H, WANG R Y, et al . Patient-specific instrumentation improved axial alignment of the femoral component, operative time and perioperative blood loss after total knee arthroplasty[J ] . Knee Surg Sports Traumatol Arthrosc, 2019, 27(4): 1083-1095.DOI: 10.1007/s00167-018-5256-0.

IVIE C B, PROBST P J, BAL A K, et al . Improved radiographic outcomes with patient-specific total knee arthroplasty[J ] . J Arthroplasty, 2014, 29(11): 2100-2103. DOI: 10.1016/j.arth.2014.06.024.

HEYSE T J, TIBESKU C O. Improved femoral component rotation in TKA using patient-specific instrumentation[J]. Knee, 2014, 21(1): 268-271. DOI: 10.1016/j.knee.2012.10.009.

HEYSE T J, TIBESKU C O. Improved tibial component rotation in TKA using patient-specific instrumentation[J]. Arch Orthop Trauma Surg, 2015, 135(5): 697-701. DOI: 10.1007/s00402-015-2157-2.

KE S, RAN T F, HE Y Q, et al . Does patient-specific instrumentation increase the risk of notching in the anterior femoral cortex in total knee arthroplasty? A comparative prospective trial[J ] . Int Orthop, 2020, 44(12): 2603-2611. DOI: 10.1007/s00264-020-04779-4.

CHAREANCHOLVANICH K, NARKBUNNAM R, PORN-RATTANAMANEEWONG C. A prospective randomised controlled study of patient-specific cutting guides compared with conventional instrumentation in total knee replacement[J]. Bone Joint J, 2013, 95-B(3): 354-359. DOI: 10.1302/0301-620X.95B3.29903.

NUNLEY R M, ELLISON B S, ZHU J J, et al . Do patient-specific guides improve coronal alignment in total knee arthroplasty?[J ] . Clin Orthop Relat Res, 2012, 470(3): 895-902. DOI: 10.1007/s11999-011-2222-2.

ZOMAR B O, VASARHELYI E M, SOMERVILLE L E, et al . A randomized trial investigating the cost-utility of patient-specific instrumentation in total knee arthroplasty in an obese population[J ] . J Arthroplasty, 2021, 36(9): 3078-3088. DOI: 10.1016/j.arth.2021.04.029.

CHRISTEN B, TANNER L, ETTINGER M, et al . Comparative cost analysis of four different computer-assisted technologies to implant a total knee arthroplasty over conventional instrumentation[J ] . J Pers Med, 2022, 12(2): 184. DOI: 10.3390/jpm12020184.

ATTARD A, TAWY G F, SIMONS M, et al . Health costs and efficiencies of patient-specific and single-use instrumentation in total knee arthroplasty: a randomised controlled trial[J ] . BMJ Open Qual, 2019, 8(2): e000493. DOI: 10.1136/bmjoq-2018-000493.

KOSSE N M, HEESTERBEEK P J C, SCHIMMEL J J P, et al . Stability and alignment do not improve by using patient-specific instrumentation in total knee arthroplasty: a randomized controlled trial[J ] . Knee Surg Sports Traumatol Arthrosc, 2018, 26(6): 1792-1799. DOI: 10.1007/s00167-017-4792-3.

VAN LEEUWEN J A M J, SNORRASON F, RÖHRL S M. No radiological and clinical advantages with patient-specific positioning guides in total knee replacement[J]. Acta Orthop, 2018, 89(1): 89-94. DOI: 10.1080/17453674.2017.1393732.

NUNLEY R M, ELLISON B S, RUH E L, et al . Are patient-specific cutting blocks cost-effective for total knee arthroplasty?[J ] . Clin Orthop Relat Res, 2012, 470(3): 889-894. DOI: 10.1007/s11999-011-2221-3.

YAMAMURA K, MINODA Y, SUGAMA R, et al . Design improvement in patient-specific instrumentation for total knee arthroplasty improved the accuracy of the tibial prosthetic alignment in the coronal and axial planes[J ] . Knee Surg Sports Traumatol Arthrosc, 2020, 28(5): 1560-1567. DOI:10.1007/s00167-019-05571-7.

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

3D打印精准智齿冠周冲洗器清除菌斑的体外研究

医学3D打印多孔钽在骨科的应用

人体心脏纤维骨架及瓣膜三维模型的构建及其3D打印模型的应用探讨

3D打印个性化截骨导板对全膝关节置换术髌骨高度和关节线位置的影响

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