一种基于“H”点的全新3D打印个性化截骨导板辅助胫骨高位截骨术的尸体研究

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摘要目的本研究设计了一款基于“H”点的全新3D打印个性化截骨导板(patient-specific instrument，PSI)，并将其应用于尸体研究，探讨其应用于胫骨高位截骨术(high tibial osteotomy，HTO)的可行性和精确性。方法纳入新鲜冰冻尸体12具，其中男性5具，女性7具；年龄53~72岁，平均(60.92±5.92)岁。12具尸体标本中共收集24个完整下肢。将完整下肢随机分为两组：(1)PSI组(14个)，采用3D术前设计和PSI导板辅助截骨；应用软件重建3D模型，在此基础上进行术前三维手术规划、导板设计、模拟截骨，3D打印出胫骨模型和PSI导板。术前设计和实际手术均使用“H”点骨性凸起作为PSI导板的定位标志。(2)对照组(10个)，采用2D术前设计和常规手术。所有标本记录术前及术后机械性胫股角(mechanical femorotibial angle，mFTA)位置、胫骨后倾角(posterior tibial slope，PTS)、术中透视次数及手术时间。结果两组术后mFTA和PTS比较，差异无统计学意义(P＝0.553和P＝0.813)，但是PSI组mFTA和PTS矫形准确率更高，有效结果更为集中，其中mFTA绝对矫形误差1°内为85.7%，对照组为60%；PTS绝对矫形误差1°内为57.1%，2°内为92.9%，对照组分别为20%和50%。PSI组在手术总时间、定位截骨时间、撑开矫形时间和总透视次数明显少于对照组，差异有统计学意义。结论以“H”点作为定位标志的全新3D打印PSI导板设计合理，能够明显提高HTO的截骨精度，缩短手术时间，减少辐射暴露。

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关键词 ：膝关节骨关节炎, 个性化截骨导板, 胫骨高位截骨术, 尸体研究

Abstract：Objective To explore the feasibility and accuracy of a novel 3D-Printed Patient-Specific Instrument(PSI) based on “H”Point for medial opening-wedge high tibial osteotomy(OWHTO) in a prospective cadaver study.Methods Twenty-four entire fresh-frozen lower limbs from twelve cadavers were collected，including 5 males and 7 females and aged 53~72 years old with mean age of (60.92±5.92).All lower limbs were randomly divided into two groups：(1)PSI group (n＝14) treated with 3D virtual preoperative planning and a novel 3D-Printed PSI；(2)control group (n＝10) with 2D planning and standard technique.Utilizing medical software and three-dimensional design software，3D models were reversely reconstructed for preoperative surgical planning，guide plate design，and simulated osteotomy.Both the preoperative design and the actual operation，“H” point bony bulge was used as the positioning mark of the PSI guide.All specimens recorded the parameters including preoperative mechanicalmedial proximal tibial angle(mMPTA)，pre-and postoperative mechanical femorotibial angle(mFTA)，pre-and postoperative posterior tibial slope(PTS)，the number of intraoperative fluoroscopy and operation time.Results There was no statistical difference between the two groups in mFTA (P＝0.553) and PTS (P＝0.813) after operation.But the absolutecorrection error of mFTA and PTS were significantly smaller in the PSI group.The effective rate of mFTA in the PSI group was more concentrated with absolute correction error within 1° for 85.7% compared to 60% in the control group.The effective rate of PTS in the PSI group was more concentrated with absolute correction error within 1° and within 2° for 57.1% and 92.9%，compared to 20% and 50% in the control group.The total operation time，positioning osteotomy time，distraction correction time and fluoroscopy dose in the PSI group were significantly less than those in the control group.Conclusion The novel 3D-Printed PSI based on "H"point is feasibility and accuracy with advantages in terms ofoperation time and radiation exposure for HTO.

Key words： knee osteoarthritis patient-specific instrument high tibialosteotomy cadaveric study

基金资助:河北省重点研发计划项目(21377770D)

通讯作者: 黄野

作者简介: 刘国彬(1979－ )，男，副主任医师，河北医科大学第一医院骨科，050030。

引用本文:

刘国彬 1，刘森 1，王立飞 1，董威 1，赵峰 1，朱超华 1，黄野 2*. 一种基于“H”点的全新3D打印个性化截骨导板辅助胫骨高位截骨术的尸体研究[J]. 实用骨科杂志, 2021, 27(10): 941-950.
Liu Guobin，Liu Sen，Wang Lifei，et al. A Novel 3D-Printed Patient-Specific Instrument based on “H” Point for Medial Opening-Wedge High Tibial Osteotomy：A Cadaver Study. sygkzz, 2021, 27(10): 941-950.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2021/V27/I10/941

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