CAJ | 학술논문

目的探讨在人工全膝关节置换术(TKA)中采用数字技术进行个体化股骨旋转定位的准确性及可行性.方法选择上海市东方医院关节外科2012年5月-2013年1 1月68例膝关节严重退变病例纳入观察组进行回顾性分析,全部病例X线检查均符合Kellgren&Lawrence分级法Ⅲ级以上,且合并严重的膝关节疼痛及活动受限.术前CT扫描下肢采集数据后利用数字化软件Mimics14.01在建立的3D立体模型中测量股骨后髁角,在TKA中参照该角度进行个体化截骨,术后再次测量股骨后髁角.选择2010年9月-2012年10月统一采用外旋3°截骨的62例患者作为对照组.比较两组手术前后股骨后髁角以及股骨假体旋转不良率.结果观察组68例采用数字技术的患者术前测得股骨后髁角5.14°±1.59°(1.05°～ 8.26°),术后0.83°±0.44°(0.03°～2.28°);对照组中62例采用传统技术的患者术前测得股骨后髁角5.47°±1.23°(1.97°～8.41°),术后3.82°±0.41°(0.08° ～6.93°).两组患者术前的股骨后髁角差异无统计学意义(t=1.349,P＞0.05),观察组术后股骨后髁角明显小于对照组,差异有统计学意义(t =39.973,P＜0.01).观察组股骨假体旋转不良率为10.3％ (7/63),对照组为38.7％ (24/62),两组比较差异有统计学意义(x2=14.420,P＜0.01).结论 TKA术前应用数字化技术测量股骨后髁角,并根据测量结果进行个体化股骨外旋截骨,可以获得良好的股骨旋转力线.
목적 탐토재인공전슬관절치환술(TKA)중채용수자기술진행개체화고골선전정위적준학성급가행성.방법 선택상해시동방의원관절외과2012년5월-2013년1 1월68례슬관절엄중퇴변병례납입관찰조진행회고성분석,전부병례X선검사균부합Kellgren&Lawrence분급법Ⅲ급이상,차합병엄중적슬관절동통급활동수한.술전CT소묘하지채집수거후이용수자화연건Mimics14.01재건립적3D입체모형중측량고골후과각,재TKA중삼조해각도진행개체화절골,술후재차측량고골후과각.선택2010년9월-2012년10월통일채용외선3°절골적62례환자작위대조조.비교량조수술전후고골후과각이급고골가체선전불량솔.결과 관찰조68례채용수자기술적환자술전측득고골후과각5.14°±1.59°(1.05°～ 8.26°),술후0.83°±0.44°(0.03°～2.28°);대조조중62례채용전통기술적환자술전측득고골후과각5.47°±1.23°(1.97°～8.41°),술후3.82°±0.41°(0.08° ～6.93°).량조환자술전적고골후과각차이무통계학의의(t=1.349,P＞0.05),관찰조술후고골후과각명현소우대조조,차이유통계학의의(t =39.973,P＜0.01).관찰조고골가체선전불량솔위10.3％ (7/63),대조조위38.7％ (24/62),량조비교차이유통계학의의(x2=14.420,P＜0.01).결론 TKA술전응용수자화기술측량고골후과각,병근거측량결과진행개체화고골외선절골,가이획득량호적고골선전력선.
Objective To validate the accuracy and feasibility of personalized femoral prosthesis rotational certification assisted by digital technology in total knee arthroplasty(TKA).Methods From May 2012 to November 2014,68 patients of severe knee joint degeneration were treated surgically by TKA.Femoral prothesis rotational certification based on the posterior condylar angle (PCA),which was measured by digital software Mimics14.01 according to preoperative CT data,could modulate the lateral rotation angle during the surgery.From September 2010 to October 2012,62 patients who received the standard TKA were set as a control group.All cases had radiographic knee osteoarthritis above grade Ⅲ according to Kellgren & Lawrence system combined with chronic knee pain and limited range of motion.Subsequently,the multislice spiral CT scan and digital calculation were performed to evaluate the accuracy of the placed prosthesis postoperatively.Results The pre-operative PCA was 5.14° ± 1.59°(range,1.05°-8.26°) in the digital group and 5.47° ± 1.23°(range,1.97°-8.41°) in the control group.There was no significant difference between the two groups preoperatively (t =1.349,P ＞ 0.05).Femoral prosthesis rotation angle was 0.83° ±0.44°(range,0.03°-2.28°) in the digital group and 3.82° ±0.41° (range,0.08°-6.93°) in the control group.There was significant difference between the two groups (t =39.973,P ＜ 0.01).The malmtation rate was 38.7％ in the control group,while the digital group was only 10.3％.There was statistic difference between the two groups (x2 =14.420,P ＜ 0.01).Conclusions Femoral prothesis rotational certification based on the PCA,which is measured by digital software Mimics14.01 according to preoperative CT data,can lead to a more personalized and accurate total knee arthroplasty.