中国组织工程研究

中国组织工程研究 ›› 2020, Vol. 24 ›› Issue (6): 821-826.doi: 10.3969/j.issn.2095-4344.2445

• 人工假体 artificial prosthesis •    下一篇

个性化膝关节抗生素骨水泥占位器的设计及临床应用

王  宏1，伍  权1，汤  耿1，张  巩2   

  1. 1贵州师范大学机械与电气工程学院，贵州省贵阳市  550025；2遵义医科大学研究生院，贵州省遵义市  563000
  • 收稿日期:2019-07-09 修回日期:2019-07-10 接受日期:2019-08-20 出版日期:2020-02-28 发布日期:2020-01-16
  • 通讯作者: 伍权，博士，副教授，硕士生导师，贵州师范大学机械与电气工程学院，贵州省贵阳市 550025
  • 作者简介:王宏，男，1990年生，辽宁省鞍山市人，满族，贵州师范大学在读硕士，主要从事增材制造技术及其应用、机械CAD/CAE研究。
  • 基金资助:
    贵州师范大学研究生创新基金资助项目(YC[2018]027)；贵州省优秀青年科技人才培养对象专项资金(黔科合人字[2015]05号)；贵州省科技计划项目(黔科合LH字[2016]7221号)；贵州师范大学资助博士科研项目(2014)

Design and clinical application of personalized antibiotic cement spacer of knee joint

Wang Hong1, Wu Quan1, Tang Geng1, Zhang Gong2   

  1. 1School of Mechanical & Electrical Engineering, Guizhou Normal University, Guiyang 550025, Guizhou Province, China; 2Graduate School of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
  • Received:2019-07-09 Revised:2019-07-10 Accepted:2019-08-20 Online:2020-02-28 Published:2020-01-16
  • Contact: Wu Quan, PhD, Associate professor, Master’s supervisor, School of Mechanical & Electrical Engineering, Guizhou Normal University, Guiyang 550025, Guizhou Province, China
  • About author:Wang Hong, Master candidate, School of Mechanical & Electrical Engineering, Guizhou Normal University, Guiyang 550025, Guizhou Province, China
  • Supported by:
    the Guizhou Normal University Graduate Innovation Foundation, No. YC[2018]027; the Foundation for Excellent Young Talents of Guizhou Province, No. [2015]05; the Science and Technology Program of Guizhou Province, No. [2016]7221; the Doctoral Foundation of Guizhou Normal University in 2014 

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摘要：

文题释义：
全膝关节置换后二期翻修：感染是人工全膝关节置换后最为严重的并发症之一，二期翻修目前被公认为是治疗膝关节假体周围感染的“金标准”。占位器在二期翻修手术治疗慢性膝关节假体周围感染中起到不可替代的作用。
膝关节占位器：为防止二次手术期间肌肉挛缩，增加膝关节腔内抗生素浓度，在膝关节翻修一期手术时需暂时置入抗生素骨水泥占位器。目前占位器种类各异，制作方法及其特性也不尽相同。

背景：膝关节假体周围感染是全膝关节置换后最严重的并发症之一，二期翻修目前被公认为是治疗的“金标准”。在二次手术的间隔期置入抗生素骨水泥占位器，不仅可以增加抗生素浓度，还可以增加患者关节活动功能。目前占位器的制作方法各不相同，存在关节面贴合度低、制作精度低、结构不稳定和强度低等缺点，无法更好的贴合患者的生理结构。如何设计出个性化占位器且维持术后膝关节稳定是占位器临床应用中的难题。

目的：利用有限元分析方法设计个性化占位器结构，采用3D打印技术制作抗生素骨水泥占位器并应用于临床。

方法：基于全膝关节置换患者膝关节CT数据，运用Mimics医学图形处理软件对假体、股骨、胫骨进行重建。根据手术截骨量、假体外形设计个性化占位器结构，利用有限元法分析占位器在不同步态的受力情况，采用3D打印技术快速制作抗生素骨水泥占位器硅胶模具并应用于临床。

结果与结论：①根据患者手术截骨量、膝关节假体外形设计了股骨侧占位器与胫骨侧占位器，为防止占位器脱位，加深了胫骨侧占位器的凹槽深度(4-6 mm)与前端高度(10-14 mm)；②有限元分析结果表明，股骨侧占位器屈曲90°时最大应力值为13.6 MPa，胫骨侧占位器屈曲90°时最大应力值为7.99 MPa，受力合理，占位器的结构强度满足要求；③采用3D打印技术制作抗生素骨水泥占位器的硅胶模具，制作的占位器表面更加光滑，配合度增加；④临床结果显示，个性化抗生素骨水泥占位器具备良好的关节活动能力与稳定性；⑤说明该方法制作的占位器快捷、简单，节约手术时间，为膝关节占位器的临床应用提供了新的选择。

ORCID: 0000-0003-3712-7665(王宏)

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程


关键词: 全膝关节置换, 二期翻修, 占位器, 个性化, 有限元分析, 3D打印

Abstract:

BACKGROUND: Periprosthetic infection of the knee is one of the most serious complications after total knee arthroplasty. Second-stage revision is recognized as the “gold standard” of treatment. The placement of antibiotic cement spacer during the interval of the second operation not only increases the concentration of antibiotics, but also increases the joint activity of patients. At present, the fabrication methods of spacer are different. There are some shortcomings such as low articular surface fit, low fabrication accuracy, unstable structure and low strength, which cannot well fit the patient’s physiological structure. How to design personalized spacer and maintain knee joint stability after surgery is a difficulty in its clinical application.

OBJECTIVE: To design the structure of personalized spacer using finite element analysis and to make a spacer by three-dimensional printing technology for applied clinically.

METHODS: Based on CT data of knee joint from patients undergoing total knee arthroplasty, the prosthesis, femur and tibia were reconstructed by Mimics software. According to the amount of osteotomy and the shape of the prosthesis, a personalized spacer structure was designed. The stress of the spacer in different gaits was analyzed by finite element method. The silicone mould of the occupier was fabricated by three-dimensional printing technology and used in clinical application.

RESULTS AND CONCLUSION: (1) According to the amount of osteotomy and the shape of knee prosthesis, the structure of femoral side occupier and the tibial side occupier were designed. In order to prevent the dislocation of the spacer, the groove depth of the tibial side occupier was (4-6 mm) and the anterior end height was (10-14 mm). (2) The results of finite element analysis showed that the maximum stress of the femoral side occupier was 13.6 MPa at 90 degrees of flexion, and that of the tibial side occupier was 7.99 MPa at 90 degrees of flexion. The stress was reasonable and the structural strength of the spacer meets the requirements. (3) Silica gel mould of spacer was made by three-dimensional printing technology. The surface of spacer was smoother and the fit degree was increased. (4) The clinical results showed that the personalized spacer had good joint mobility and stability. (5) The spacer made by this method is fast, simple and saves operation time. It provides a new choice for clinical application of knee joint spacer.

Key words: total knee arthroplasty, second-stage revision, spacer, personalized, finite element analysis, three-dimensional printing

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