3D 打印个体化胫骨高位截骨导板的有效性和准确性：尸体研究。
The validity and accuracy of 3D-printed patient-specific instruments for high tibial osteotomy: a cadaveric study.
机构信息
Department of Orthopedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
出版信息
J Orthop Surg Res. 2022 Jan 29;17(1):62. doi: 10.1186/s13018-022-02956-2.
OBJECTIVE
High tibial osteotomy (HTO) has been used for the treatment of patients with knee osteoarthritis. However, the successful implementation of HTO requires precise intraoperative positioning, which places greater requirements on the surgeon. In this study, we aimed to design a new kind of 3D-printed patient-specific instrument (PSI) for HTO, including a positioning device and an angle bracing spacer, and verify its effectiveness using cadaveric specimens.
METHODS
This study included ten fresh human lower-limb cadaveric specimens. Computed tomography (CT) and X-ray examinations were performed to make preoperative plans. PSI was designed and 3D-printed according to the preoperative plan. Then, the PSI was used to guide HTO. Finally, we performed X-ray and CT after the operation to verify its validity and accuracy.
RESULTS
The PSI using process was adjusted according to the pre-experimental procedure in 1 case. Hinge fracture occurred in 1 case. According to X-rays of the remaining eight cadaveric specimens, no statistically significant difference was noted between the preoperative planning medial proximal tibial angle (MPTA) and postoperative MPTA (P > 0.05) or the preoperative and postoperative posterior slope angle (PSA) (P > 0.05). According to the CT of 10 cadaveric specimens, no statistically significant difference was noted between the design angle and actual angle, which was measured according to the angle between the osteotomized line and the cross section (P > 0.05). The gap between the designed osteotomy line and the actual osteotomy line was 2.09 (0.8 ~ 3.44) mm in the coronal plane and 1.58 (0.7 ~ 2.85) mm in the sagittal plane.
CONCLUSION
This 3D-printed PSI of HTO accurately achieves the angle and position of the preoperative plan without increasing the stripping area. However, its use still requires a certain degree of proficiency to avoid complications, such as hinge fracture.
目的
胫骨高位截骨术（HTO）已被用于治疗膝关节骨关节炎患者。然而，HTO 的成功实施需要精确的术中定位，这对外科医生提出了更高的要求。本研究旨在设计一种新的用于 HTO 的 3D 打印患者特异性器械（PSI），包括定位装置和角度支撑间隔物，并通过尸体标本验证其有效性。
方法
本研究纳入了 10 例新鲜的人下肢尸体标本。进行了计算机断层扫描（CT）和 X 射线检查以制定术前计划。根据术前计划设计并 3D 打印 PSI。然后，使用 PSI 引导 HTO。最后，我们在手术后进行 X 射线和 CT 检查以验证其有效性和准确性。
结果
1 例根据预实验过程调整了 PSI 使用过程。1 例发生铰链骨折。根据其余 8 例尸体标本的 X 射线检查，术前规划内侧近端胫骨角（MPTA）与术后 MPTA 之间无统计学差异（P＞0.05）或术前和术后后倾角（PSA）之间无统计学差异（P＞0.05）。根据 10 例尸体标本的 CT，设计角度与实际角度之间无统计学差异，这是根据截骨线与横截面之间的角度（P＞0.05）测量的。冠状面设计截骨线与实际截骨线之间的间隙为 2.09（0.8～3.44）mm，矢状面为 1.58（0.7～2.85）mm。
结论
这种用于 HTO 的 3D 打印 PSI 可以准确实现术前计划的角度和位置，而不会增加剥离面积。然而，其使用仍然需要一定程度的熟练度，以避免铰链骨折等并发症。
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