摘要目的 探究3D打印截骨导向器在全膝关节置换术中的临床应用价值和精准性。方法 2015年6月至2017年6月共纳入10例骨关节炎患者，其中男4例，女6例；年龄61~81岁，平均年龄76岁。所有患者均行双下肢多排双源螺旋CT平扫，利用计算机软件Mimics 17.0对患者下肢CT导出的DICOM格式数据进行骨骼数据建模，测量力线和畸形角度，重建骨骼模型；使用UG(Unigraphics)NX 8.5进行数字化截骨导向器设计和术前模拟截骨操作；术中使用SLA 3D打印机制造导向器进行截骨定位，安装假体，术后复查膝关节正侧位X线片，记录术前、术后4周的美国特种外科医院(hospital for special surgery，HSS)膝关节评分情况、膝关节活动度(range of motion，ROM)、下肢力线角度(股骨与胫骨机械轴的夹角)。结果 所有患者手术过程顺利，膝关节假体位置良好，关节间隙平行等宽，膝关节畸形得以矫正，术后4周HSS评分为(86.2±2.53)分，关节活动度ROM为(101.7±2.54)°，下肢力线角度(股骨与胫骨机械轴的夹角)为(1.93±0.31)°。患者均恢复满意膝关节活动度和正常的下肢生物学力线。结论 数字化3D打印截骨导向器应用于全膝关节置换术可简化手术步骤，提高截骨精准性，获得良好的下肢力线，为全膝关节置换术(total knee arthroplasty，TKA)提供了一种简便、有效的方法。
Abstract：Objective To explore value and accuracy of 3D printing osteotomy guider in total knee arthroplasty.Methods From June 2015 to June 2017，10 patients with osteoarthritis，including 4 males and 6 females，aged 61 to 81 years，with an average age of 76 years，were treated with double lower limb multiple row dual-source spiral CT scan.The data were analyzed by DICOM in computer software Mimics 17.0，and the skeletal model was reconstructed by measuring the force line and deformity angle.The digital osteotomy guiders were designed and the preoperative simulated osteotomy was operated by adopting UG(Unigraphics )NX 8.5；In the operation，the SLA 3D printing manufacturing guiders were used for osteotomy positioning，installation of prosthesis，postoperative knee joint X-ray examination，recording HSS(Hospital for Special Surgery) score of preoperative and postoperative 4 weeks，the range of motion(ROM) and lower limb force line angle(femoral and tibial mechanical axis angle).Results All patients underwent smooth operation with good position of knee prosthesis，parallel joint clearance and equal width.Their knee joint deformities were redressed；the HSS score was(86.2±2.53) 4 weeks after surgery；the ROM of knee is (101.7±2.54)°；lower limb power line Angle(femoral and tibial mechanical axis angle) was (1.93±0.31)°.Patients were satisfied with knee activity and normal lower limb alignment.Conclusion Digital 3D printing osteotomy can be used in total knee arthroplasty to simplify the operation，improve the accuracy of osteotomy and obtain a good mechanical alignment of lower limb.It provides a simple and effective method for TKA operation.
贺统 1，李凡 2，杨晶 2，倪鹏辉 3，杨宇 4，刘大鹏 2*. 数字化3D打印截骨导向器在全膝关节置换术中的应用研究[J]. 实用骨科杂志, 2018, 24(4): 310-313.
He Tong 1，Li Fan 2，Yang Jing 2，et al. Application of Digital 3D Printed Osteotomy Guider in Total Knee Arthroplasty. sygkzz, 2018, 24(4): 310-313.
［1］Matsuda S，Kawahara S，Okazaki K，et al.Postoperative alignment and ROM affect patient satisfaction after TKA［J］.Clin Orthop Relat Res，2013，471(1)：127-133.
［2］Park A，Nam D，Friedman MV，et al.Inter-observer precision and physiologic variability of mri landmarks used to determine rotational alignment in conventional and patientspecific TKA［J］.J Arthroplasty，2015，30(2)：290-295.
［3］Chung KJ，Hong DY，Kim YT，et al.Preshaping plates for minimally invasive fixation of calcaneal fractures using a real-size 3D-printed model as a preoperative and intraoperative tool［J］.Foot Ankle Int，2014，35(11)：1231.
［4］邱贵兴.中国骨科大手术静脉血栓栓塞症预防指南［J］.中华骨科杂志，2016，36(2)：70-72.
［5］徐建平，徐卫东，林国兵，等.双膝骨关节炎患者行小切口单髁置换术与全膝关节置换术临床疗效对比分析［J］.中华外科杂志，2013，51(2)：157-160.
［6］Fang DM，Ritter MA，Davis KE.Coronal alignment in total knee arthroplasty：just how important is it?［J］.J Arthroplasty，2009，24(6 Suppl)：39-43.
［7］Cheng T，Zhao S，Peng X，et al.Does computer-assisted surgery improve postoperative leg alignment and implant positioning following total knee arthroplasty? A meta-analysis of randomized controlled trials?［J］.Knee Surg Sports Traumatol Arthrosc，2012，20(7)：1307-1322.
［8］Zhao J，Zhang J，Ji X，et al.Does intramedullary canal irrigation reduce fat emboli? A randomized clinical trial with transesophageal echocardiography［J］.J Arthroplasty，2015，30(3)：451-455.
［9］Hafez MA，Chelule KL，Seedhom BB，et al.Computer-assisted total knee arthroplasty using patient-specific templating［J］.Clin Orthop Relat Res，2006(444)：184-192.
［10］甘煜东.计算机辅助个体化导航模板在膝关节置换中的应用基础研究［D］.广州：南方医科大学，2012：1-97.
［11］张元智，裴国献，陆声，等.计算机辅助确定下肢机械轴线在全膝关节置换术中的应用［J］.中华骨科杂志，2013，33(12)：1196-1203.
［12］刘帅，姚庆强，田书畅，等.3D打印截骨槽导板与定位钉导板在全膝关节置换术中的对比研究［J］.中国骨与关节杂志，2017，6(5)：334-339.
［13］邱冰，张明娇，唐本森，等.个性化手术导板在全膝关节置换术中的应用［J］.中华骨科杂志，2016，36(3)：143-150.
［14］邱冰，唐本森，邓必勇，等.基于三维反求技术和计算机辅助技术的3D打印导板在全膝关节置换术中的初步应用［J］.中华创伤骨科杂志，2016，18(1)：35-41.
［15］吴东迎，袁峰，吴继彬，等.3D打印截骨导板在人工全膝关节置换术中的应用［J］.中华骨科杂志，2015，35(9)：921-926.
［16］Deep K，Shankar S，Mahendra A.Computer assisted navigation in total knee and hip arthroplasty［J］.SICOT J，2017(3)：50.
［17］张进，田晓滨，王少白，等.两种3D打印截骨导板在全膝关节置换模型预手术的应用探讨［J］.中华创伤骨科杂志，2016，18(1)：11-16.
［18］Kim YH，Park JW，Kim JS.The clinical outcome of computer-navigated compared with conventional knee arthroplasty in the same patients：a prospective，randomized，double-blind，long-term study［J］.J Bone Joint Surg( Am)，2017，99(12)：989-996.
晋公网安备 14010702070875号