| 吴东,尹济琛,卢江枫,等.个性化定制手术导板在全髋关节置换术中的应用.骨科,2019,10(5): 372-378. |
| 个性化定制手术导板在全髋关节置换术中的应用 |
| Application of patient specific instrumentation in total hip arthroplasty |
| 投稿时间：2019-08-16 |
| DOI：10.3969/j.issn.1674-8573.2019.05.002 |
| 中文关键词: 个性化导板 计算机辅助技术 3D打印 全髋关节置换术 |
| 英文关键词: |
| 基金项目:国家自然科学基金（81772320） |
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| 中文摘要: |
| 目的 设计并验证一种全髋关节置换术（total hip arthroplasty, THA）个性化定制手术导板（patient specific instrumentation, PSI）的安全性、有效性。方法 对患有髋关节疾病且须行THA的病人进行层厚为0.8 mm的三维CT扫描，获取该病人的CT数据。将数据导入三维手术规划软件中进行处理，根据病人术前影像学检查结果，利用计算机辅助技术（computer aided design, CAD），由经验丰富的外科医生对CT图像进行分割并重建，获得骨盆及双下肢三维模型，并在此模型基础上进行三维手术规划。通过3D打印技术，制作病人个性化定制的手术导板，用于在术中提供相应手术操作的定位导航，使假体安放的实际位置和角度与术前计划一致。结果 导板与髋臼、股骨侧的骨骼标志性结构贴合度为100%，截骨高度与术前计划一致，均为股骨小转子上9 mm，髋臼杯磨锉、压配角度控制在外展40°，前倾20°，与术前计划一致。手术时间缩短至54 min，术中失血量减少至376.9 ml。结论 此个性化定制THA手术导板可精确贴合手术部位骨质，显著提高THA的精准性，具有良好的安全性、有效性。 |
| 英文摘要: |
| Objective To design a patient specific instrumentation (PSI) with sufficient safety and effectiveness for total hip arthroplasty (THA). Methods The three-dimensional CT scan with thickness of 0.8 mm was performed on the patients with hip disease requiring THA. The CT DICOM data were then imported into 3D preoperative planning system for processing. According to the preoperative imaging examination of patients, the CT images were segmented by experienced surgeons and reconstructed by computer-aided design (CAD). After that, the experienced surgeons planed preoperatively on the 3D models of pelvis and lower limbs. PSI could be printed by 3D printing technology to provide navigation during the operation, in order to achieve the best position of the acetabular component and the femur component. Results The conformity of the guide plate to the symbolic structure of the acetabulum and femur was 100%. The height of osteotomy was the same as the preoperative plan, which was 9 mm above the lesser trochanter of the femur. The angle of the acetabulum cup grinding file and pressing was controlled at 40° of abduction and 20° of anteversion, which was consistent with the preoperative plan. The operation time was shortened to 54 min and the intraoperative blood loss was reduced to 376.9 ml. Conclusion This PSI can fit with the bone landmark structure of acetabular and femoral side to the greatest extent, and significantly improve the accuracy, with good security, effectiveness. |
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