Haglin Jack M, Eltorai Adam E M, Gil Joseph A, Marcaccio Stephen E, Botero-Hincapie Juliana, Daniels Alan H
Brown University, Providence, Rhode Island, USA.
Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Orthop Surg. 2016 Nov;8(4):417-424. doi: 10.1111/os.12282.
Patient-specific orthopaedic implants are emerging as a clinically promising treatment option for a growing number of conditions to better match an individual's anatomy. Patient-specific implant (PSI) technology aims to reduce overall procedural costs, minimize surgical time, and maximize patient outcomes by achieving better biomechanical implant fit. With this commercially-available technology, computed tomography or magnetic resonance images can be used in conjunction with specialized computer programs to create preoperative patient-specific surgical plans and to develop custom cutting guides from 3-D reconstructed images of patient anatomy. Surgeons can then place these temporary guides or "jigs" during the procedure, allowing them to better recreate the exact resections of the computer-generated surgical plan. Over the past decade, patient-specific implants have seen increased use in orthopaedics and they have been widely indicated in total knee arthroplasty, total hip arthroplasty, and corrective osteotomies. Patient-specific implants have also been explored for use in total shoulder arthroplasty and spinal surgery. Despite their increasing popularity, significant support for PSI use in orthopaedics has been lacking in the literature and it is currently uncertain whether the theoretical biomechanical advantages of patient-specific orthopaedic implants carry true advantages in surgical outcomes when compared to standard procedures. The purpose of this review was to assess the current status of patient-specific orthopaedic implants, to explore their future direction, and to summarize any comparative published studies that measure definitive surgical characteristics of patient-specific orthopaedic implant use such as patient outcomes, biomechanical implant alignment, surgical cost, patient blood loss, or patient recovery.
针对特定患者的骨科植入物正逐渐成为一种具有临床前景的治疗选择，适用于越来越多的病症，以更好地匹配个体解剖结构。针对特定患者的植入物（PSI）技术旨在通过实现更好的生物力学植入物适配，降低总体手术成本，减少手术时间，并使患者预后最大化。借助这种商业可用技术，计算机断层扫描或磁共振图像可与专门的计算机程序结合使用，以创建术前针对特定患者的手术计划，并根据患者解剖结构的三维重建图像开发定制切割导板。然后，外科医生在手术过程中可以放置这些临时导板或“夹具”，使他们能够更好地重现计算机生成的手术计划中的精确切除操作。在过去十年中，针对特定患者的植入物在骨科中的使用有所增加，并且已广泛应用于全膝关节置换术、全髋关节置换术和矫正截骨术。针对特定患者的植入物也已在全肩关节置换术和脊柱手术中进行了探索。尽管它们越来越受欢迎，但文献中缺乏对PSI在骨科中使用的大量支持，目前尚不确定与标准手术相比，针对特定患者的骨科植入物的理论生物力学优势在手术结果中是否具有真正的优势。本综述的目的是评估针对特定患者的骨科植入物的现状，探索其未来方向，并总结任何已发表的比较研究，这些研究测量了使用针对特定患者的骨科植入物的明确手术特征，如患者预后、植入物生物力学对线、手术成本、患者失血量或患者恢复情况。
