Rosso Federica, Rossi Roberto, Neyret Philippe, Śmigielski Robert, Menetrey Jacques, Bonasia Davide Edoardo, Fucentese Sandro Franco
Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, Largo Turati 62, 10128, Turin, Italy.
Infirmerie Protestante, 3 Rue Penthod, 69300, Caluire, France.
J Exp Orthop. 2023 Aug 9;10(1):80. doi: 10.1186/s40634-023-00647-3.
The aim of this study was to evaluate the accuracy of a patient-specific cutting guide on both coronal and sagittal alignment compared to the pre-operative planning in OWHTO.
Twelve OWHTO on 6 cadaveric specimens were performed by 3 experienced knee surgeons using patient-specific cutting guides based on 3D pre-operative planning. Since the specimens had no major deformities, a fixed correction of 6° on the left and 10° on the right legs were carried out to simulate different scenarios. A pre-operative and post-OWHTO 3D CT scans were performed, and images were superimposed using the dedicated 3D planning software to align their reference axes. A pre-operative planning was performed considering both Medial Proximal Tibial Angle (MPTA) and Posterior Tibial Slope (PTS), and a patient-specific cutting guide was produced. Planned and post-OWHTO MPTA and PTS were evaluated (mean and standard deviation), and Pearson's correlation coefficient was calculated to assess precision and accuracy of the whole treatment.
A mean correction of 6,1° (SD 1,9°) and 1,2° (SD 1°) was obtained respectively in the coronal plane (MPTA) and in the sagittal plane (PTS). The average difference between planned and post-OWHTO MPTA and PTS was respectively 1,2° (SD 0,6°) and 1,2° (SD 1°) in the sagittal plane (PTS). Pearson's correlation coefficient demonstrated a good accuracy of the treatment in both coronal and sagittal plane (respectively r=0,95 and r=0,86). No lateral hinge fractures were detected at the post-operative CT scan.
OWTHO performed with the help of 3D patient specific cutting guide on cadaveric specimens demonstrated good accuracy and reliability in obtaining the planned correction. In vivo studies are necessary to confirm these results and evaluate cost-effectiveness of this system.
Level IV cadaveric study.
本研究旨在评估在全膝关节置换术（OWHTO）中，与术前规划相比，定制截骨导板在冠状面和矢状面的对线精度。
3位经验丰富的膝关节外科医生使用基于三维术前规划的定制截骨导板，对6具尸体标本进行了12次OWHTO手术。由于标本无明显畸形，故在左腿进行6°、右腿进行10°的固定矫正，以模拟不同情况。术前及OWHTO术后均进行三维CT扫描，并使用专用三维规划软件对图像进行叠加，以对齐其参考轴。术前规划时同时考虑内侧胫骨近端角（MPTA）和胫骨后倾（PTS），并制作定制截骨导板。评估计划的和OWHTO术后的MPTA及PTS（均值和标准差），并计算Pearson相关系数，以评估整个治疗的精度和准确性。
在冠状面（MPTA）和矢状面（PTS）分别获得了平均6.1°（标准差1.9°）和1.2°（标准差1°）的矫正。矢状面（PTS）上，计划的和OWHTO术后的MPTA及PTS的平均差异分别为1.2°（标准差0.6°）和1.2°（标准差1°）。Pearson相关系数表明，在冠状面和矢状面治疗均具有良好的准确性（分别为r = 0.95和r = 0.86）。术后CT扫描未检测到外侧铰链骨折。
在尸体标本上借助三维定制截骨导板进行的OWHTO在获得计划的矫正方面显示出良好的准确性和可靠性。需要进行体内研究以证实这些结果并评估该系统的成本效益。
IV级尸体研究。
