Application of personalized osteotomy guide plate in medial pivot knee prosthesis replacement based on MRI and three-dimensional CT

doi:10.3969/j.issn.2095-4344.2807

Abstract

Abstract:

BACKGROUND: Personalized positioning guide plate based on three-dimensional CT data can improve the accuracy of posterior-stabilized prosthesis joint replacement, but bone structure reconstruction based on three-dimensional CT scan data ignores the thickness of distal femoral articular cartilage, which will affect the use of personalized osteotomy guide plate and the clinical effect of total knee arthroplasty.

OBJECTIVE: To investigate the safety, accuracy and early clinical efficacy of three-dimensional printed screw positioning guide based on MRI and three-dimensional CT assisted medial pivot-total knee arthroplasty in the treatment of osteoarthritis.

METHODS: A total of 110 patients with knee osteoarthritis admitted to Department of Orthopedics, Nanjing Hospital Affiliated to Nanjing Medical University from February 2018 to April 2019 were selected. All patients received medial pivot-total knee arthroplasty, and were randomly assigned to two groups. The 58 patients in the experimental group completed knee osteotomy with the assistance of personalized osteotomy guide plate based on MRI and three-dimensional CT. The 52 patients in the control group completed knee osteotomy with the traditional intramedullary and extramedullary positioning methods. The operation time and intraoperative blood loss of the two groups were recorded. Postoperative follow-up was conducted to review the X-ray films. KSS score of knee function and the visual analogue scale score were evaluated.

RESULTS AND CONCLUSION: (1) 110 patients were followed up for 6-10 months without serious postoperative complications. (2) The operation time and intraoperative blood loss in the experimental group were less than those in the control group (P < 0.01). (3) According to the reexamination of X-ray at 1 month after surgery, the deviation between the postoperative values and the theoretical design values of hip-genus-ankle angle, coronal femoral component angle, coronal tibial component angle and sagittal tibial component angle were all smaller in the experimental group than those of the control group (P < 0.01). (4) KSS score of knee joint function in the experimental group 1, 3 and 6 months after the surgery was higher than that in the control group (P < 0.05). There was no significant difference in visual analogue scale score between the two groups (P > 0.05). (5) The results showed that the personalized osteotomy guide plate assisted internal axial knee prosthesis replacement based on MRI and three-dimensional CT could effectively improve the accuracy of prosthesis placement and shorten the operation time. The method was safe and feasible, and the early clinical effect was satisfactory.

Key words: osteoarthritis, 3D printing, three-dimensional CT, MRI, navigation template, medial pivot knee prosthesis, total knee arthroplasty

CLC Number:

Li Xuxiang, Zhang Huikang, Wei Bo, Yao Qingqiang, Xu Yan, Tang Cheng, Wang Liming. Application of personalized osteotomy guide plate in medial pivot knee prosthesis replacement based on MRI and three-dimensional CT[J]. Chinese Journal of Tissue Engineering Research, 2020, 24(30): 4835-4840.

Figures/Tables 11

膝关节模拟手术及截骨导板设计：将mimics软件中获得的STL文件导入到 3-matics(Materialise，比利时)。股骨远端截骨：股骨机械轴定义为股骨头的中心点与膝关节的中心点连线。股骨头中心点：选取股骨头附近点云，将股骨头拟合为球形，中心即股骨头中心点。膝关节中心点：外科通髁轴与whitesides线交点即膝关节中心点，即可确定股骨机械轴，与股骨解剖轴约成5°角。将股骨远端以垂直于股骨机械轴方向行10 mm截骨。接着过股骨外科通髁轴做垂直于远端截骨面的垂面，即后髁截骨面，通过平移后髁截骨面行10 mm后髁截骨。股骨远端及后髁截骨面确定后即可模拟安装假体，微调假体位置并根据已知的假体型号参数确定股骨髁假体型号大小，当假体前后髁测量值介于两型号之间时，取测量数值接近的假体型号，通过股骨组件位置定位出配套股骨远端截骨器、四合一截骨器的定位钉孔位置，股骨侧导板非全关节面贴合设计，将股骨前皮质区域及内外侧髁侧方3处无软骨的区域作为特征性骨面，按照骨性标志放置导板。将股骨远端定位导板保存为STL文件。股骨端导板的制作见图2。胫骨平台截骨：胫骨机械轴定义为膝关节中心点与踝关节中心点的连线。胫骨平台中心点：垂直与胫骨机械轴方向截取5 mm厚胫骨平台块，去除平台骨坠，此时胫骨平台块质心即为胫骨平台中心点。踝关节中心点：选取踝区顶部区域几何中心点做为踝关节中心点。胫骨外侧平台截骨面后倾3°，以内侧髁关节面下方2 mm或外侧髁关节面下方10 mm为参照模拟截骨，再虚拟安装胫骨假体，并调整到合适位置，根据假体三维模型确定胫骨平台假体型号大小，通过胫骨组件位置定位截骨板钉孔位置。胫骨侧导板将胫骨内外侧平台前侧面及胫骨髁间棘3处区域作为特征性骨面用于放置导板，将胫骨侧定位导板保存为STL文件。胫骨端导板的制作见图3。 "

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