Steinert A F, Sefrin L, Hoberg M, Arnholdt J, Rudert M
Orthopädische Klinik, König-Ludwig-Haus, Lehrstuhl für Orthopädie, Julius-Maximilians-Universität, Brettreichstr. 11, 97074, Würzburg, Deutschland,
Orthopade. 2015 Apr;44(4):290-2, 294-301. doi: 10.1007/s00132-015-3104-1.
This article describes the rationale and the surgical technique of patient-specific uni-, bi-, or three-compartmental knee arthroplasty using the second generation (G2) of ConforMIS™ technology. The patient-individual implants and instruments are designed and fabricated based on data from a preoperative computed tomography of the lower limb. The disposable patient-specific drill guides and cutting-jigs are manufactured under consideration of the anatomical and biomechanical axes of the knee joint and mediate efficient pre-navigation of the saw-cuts on the femoral and tibial bone without the need for an additional navigation or balancing device. The surgical technique for all types of knee resurfacement comprises the steps of cartilage removal, knee balancing in extension and flexion, sparing bony cuts, final preparation of femur and tibia, trialling, cementing of components and final choice of tibial insert. The use of individualized three-dimensional image-derived resurfacing implants, as well as personalized single-use instrumentation, facilitates the surgeon to perform an almost anatomical knee resurfacement that has the potential to restore almost normal knee kinematics. The limited data on this novel technology is promising, however long-term clinical data is needed for final evaluation of this technology.
本文介绍了使用第二代ConforMIS™技术进行患者特异性单髁、双髁或三髁膝关节置换术的基本原理和手术技术。患者个体化植入物和器械是根据术前下肢计算机断层扫描数据设计和制造的。一次性使用的患者特异性钻孔导向器和切割夹具是在考虑膝关节解剖和生物力学轴线的情况下制造的,可在不使用额外导航或平衡装置的情况下,对股骨和胫骨上的锯切进行有效的预导航。所有类型膝关节表面置换的手术技术包括软骨去除、伸直和屈曲位膝关节平衡、保留骨皮质切开、股骨和胫骨的最终准备、试模、组件固定以及胫骨衬垫的最终选择。使用个体化的三维图像衍生表面置换植入物以及个性化的一次性器械,有助于外科医生进行几乎符合解剖结构的膝关节表面置换,有可能恢复几乎正常的膝关节运动学。关于这项新技术的有限数据很有前景,但需要长期临床数据才能对该技术进行最终评估。