Entry point of an intramedullary rod in knee arthroplasty: determined using singular value decomposition method

doi:10.12307/2022.689

Abstract

Abstract: BACKGROUND: During knee arthroplasty, prosthesis alignment is a key point, which has a great impact on the life span of implants. The role of an intramedullary rod in the intraoperative alignment of prostheses implanted has been verified. Excessive insertion error of the intramedullary rod will increase the probability of prosthesis implantation failure and medial bone collapse. Moreover, the insertion path depends on the determination of anatomical axis.
OBJECTIVE: To improve the computer-aided method for positioning the anatomical axis based on singular value decomposition, so as to improve the insertion accuracy of intramedullary rod and prolong the life span of prostheses implanted.
METHODS: We processed preoperative computed tomography images from nine patients scheduled for total knee arthroplasty, and reconstructed the three-dimensional model of the femur using MIMICS RESEARCH 17.0. MATLAB2018b software was subsequently used to improve the positioning of the anatomical axis of the femur using singular value decomposition method. Insertion of the intramedullary rod was simulated based on the anatomical axis fitted using multi-point method. After that, the model was introduced into 3-matic, and angle error was measured. Traditional method by which the anatomical axis was fitted by two-point method and the recommended method described above were compared and verified through the simulated insertion of the intramedullary rod.
RESULTS AND CONCLUSION: The varus and valgus angles measured by the multi-point method were (1.99±1.03)° and (2.35±1.34)°, respectively. The anterior and posterior offset angles were (1.83±0.67)° and (1.60±1.82)°, respectively. Compared with the traditional surgical method, the recommended method could improve the positioning accuracy, by which the average angle error was reduced by 0.41°. Therefore, the recommended method described above helps further improve the accuracy of prosthesis alignment in total knee arthroplasty and prolong the lifespan of prostheses implanted.

Key words: knee arthroplasty, intramedullary rod, singular value decomposition method, three-dimensional reconstruction, computer-aided

CLC Number:

Wang Zhen, Xu Yi, Tu Yihui. Entry point of an intramedullary rod in knee arthroplasty: determined using singular value decomposition method[J]. Chinese Journal of Tissue Engineering Research, 2022, 26(18): 2828-2833.

Figures/Tables 7

以推荐点作为入针点时髓内杆插入后所产生的最大潜在误差，除后部偏移角度范围在3°以内，其余方向的角度误差均大于3°。最大的误差角度为7.73°，为男性股骨的后部偏移角度；最小的误差角度为0.42°，为女性股骨的后部偏移角度；男性髓内杆入针后误差角度普遍大于女性。所有病例均有误差大于3°的误差方向。 2.3 性别对入针误差角度的影响两点法男性股骨髓内定位杆在股骨管内冠状面最大的内翻误差角度范围为为2.24°-4.14°，外翻误差角度为2.19°-3.97°；女性股骨髓内定位杆在股骨管内冠状面的内翻角度范围最大为1.84°-3.17°，外翻误差角度范围为1.58°-2.47°。在矢状面上，男性患者股骨髓内定位杆的最大前后偏移量范围分别为1.46°-3.73°，1.16°-2.98°；女性的最大偏移量为1.63°-2.16°，1.16°-2.35°。此次研究提出的基于计算机辅助入针点的寻找方法(多点法)男性股骨髓内定位杆在股骨管内冠状面最大的内翻误差角度范围为1.24°-2.73°，外翻误差角度为2.21°-3.08°；女性股骨髓内定位杆在股骨管内冠状面的内翻角度范围最大为1.77°-2.10°，外翻误差角度范围为1.01°-2.77°。在矢状面上，男性患者股骨髓内定位杆的最大前后偏移量范围分别为1.16°-2.41°、0.91°-3.42°；女性的最大偏移量为1.58°-2.17°、1.24°-1.49°。无论是在传统手术方法下还是在此次研究的试验方法，男性患者在进行髓内杆入针时的误差角度普遍大于女性患者。 2.4 显著性分析将测量得到两点法与多点法的角度误差数据导入SPSS，对其进行显著性分析，得到的P值为0.012 < 0.05，所以两组数据差异有显著性意义；推荐点插入髓内杆得到的结果与多点法结果进行显著性分析，得到的P值为 0.00 < 0.05。即多点法测量出的髓内定位杆插入产生的最大潜在角度误差明显小于两点法以及推荐点入针的髓内定位杆插入时产生的角度误差。"

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