3D打印定制化截骨导板辅助胫骨畸形一期截骨+全膝关节置换1例报告

胫骨畸形多见于胫骨骨折术后骨折畸形愈合,占所有胫骨骨折的2%~12%[1],患者常出现下肢力线偏移现象。而胫骨畸形和力线不良会改变患者的膝、踝关节的负荷传导,导致患者出现下肢疼痛、关节功能障碍等不适症状,进而加速下肢关节骨关节炎进展,严重影响患者的生活质量[2]。为了矫正畸形、缓解疼痛、防止继发性骨关节炎的发生,骨科医生尝试了多种外科手术方式,如截骨矫形术、髓内钉或钢板固定、关节置换等[3-4],而截骨矫形是改善下肢力线的主要方式,能大幅减小复杂关节置换的困难程度[5]。为了能准确纠正畸形,精确的术前规划必不可少。传统的截骨矫形术,多由高年资医生按照二维的X线片测量,凭借其临床经验进行操作,受主观因素的影响较大,可能会出现截骨角度、方向的失误,难以实现解剖重建的最优化。此外,由于骨骼畸形的性质是三维的、多平面的[6],因此,基于传统的二维X线片制定的术前规划已被证实无法满足对骨骼三维畸形的观察,难以实现精确的术前规划[7],截骨准确性难以保证。而术前CT三维重建技术能够提供更加直观的骨性解剖标志,和分析畸形程度,但难以在三维空间内为多平面的复杂畸形提供准确的量化评估[8],同时不能为保证术前规划在术中精准实施[9]。     

下肢关节内骨折术中三维成像的图像评价

目的 评价下肢关节内骨折术中三维成像(Axcadis orbit 3D)的图像质量.方法 2009年3月至12月对20例下肢关节内骨折患者(髋臼骨折8例、胫骨平台骨折8例及踝关节骨折4例)行术中三维成像.由5位医生按照设计的评分系统对这些图像进行评分,并与螺旋CT图像进行比较.结果 Arcadis orbic 3D术中成像满意,对皮质骨的显示及临床诊断意义方面平均得分为1.8分和1.6分,与CT得分相同.Arcadis orbic 3D对松质骨骨小梁显示比较模糊,得分3.2分,难以显示骨内病灶以及周嗣的软组织;金属伪影也比较大,平均得分为3.0分;三维重建效果也不理想,无论是表面重建技术,还是容积重建技术生成的立体三维图像都无法与螺旋CT相比,差异均有统计学意义.结论 在下肢关节内骨折手术中使用Arcadis orbic 3D临床十扰小,获得的术中三维断层图像质量能满足创伤骨科的临床需求.     

EOSTM 3D影像系统诊断复发性髌骨脱位的可靠性和稳定性

目的 探讨EOS^TM 3D影像系统诊断复发性髌骨脱位的可靠性和稳定性。方法 回顾性分析2022年3月至2023年3月西安交通大学附属红会医院运动医学中心收治的22例（26膝）复发性髌骨脱位病人的影像学资料,两位影像学医生同时使用EOS^TM系统测量病人下肢力线,使用sterEOS软件对影像图片进行3D模型重建,并在三维模型中测量胫骨结节-股骨滑车沟（tibial tubercle-trochlear groove,TT-TG）间距,记录每次测量所需的时间和相关参数。所有病人同期进行常规膝关节CT扫描及三维重建。将EOS^TM 3D影像和CT扫描测量的TT-TG数值进行比较,采用一致性检验研究和Bland-Altman分析图评价测量结果数据的可靠性和稳定性。结果 进行EOS^TM下肢力线测量时,不同测量者间测量的股骨和胫骨长度、膝关节内外翻角度及股骨胫骨旋转角度之间差异无统计学意义（P＞0.05）。病人常规下肢CT扫描及三维重建测量时间为（21.8±3.2） min（13~29 min）,EOS^TM 3D测量时间为（6.3±1.8） min（4~11 min）,差异有统计学意义（t=12.693,P＜0.001）。两位医生使用EOS^TM 3D测量TT-TG值的组内相关系数为0.791,使用常规CT测量的组内相关系数为0.843,两种测量方法组内一致性均较好。Bland-Altman分析结果显示两位测量者分别有96.2%（25/26）、92.3%（24/26）的点位于±1.96标准差范围内,显示使用常规CT三维重建和EOS^TM 3D测量TT-TG值具备较好的一致性和稳定性。结论 使用EOS^TM 3D影像系统测量复发性髌骨脱位病人的TT-TG值,具有良好的可靠性及可重复性,具有检查时间短、辐射低等优势,是评估此类病人下肢力线数据的一种快捷、可靠及稳定的方法。     

3D打印截骨模块在全膝关节置换术中的应用研究进展

3D打印技术是基于计算机三维数字成像技术和多层堆叠打印技术的一种新兴应用技术。该技术改变了传统的减式材料制造模式,带来了制造工艺和生产模式的变革。该技术应用于人工膝关节置换领域,制作个体化的截骨模块,能够使手术获得精确的下肢力线,具有个体化、精准化、数字化、符合加速康复外科理念等诸多优点,可以对膝关节置换术起到良好的辅助作用。随着该技术在临床中的应用越来越广泛,其缺点和不足逐渐显现。近年来对于改进3D打印截骨模块在全膝关节置换术中应用的研究报道逐渐增多,本文就新研究和进展进行文献综述。     

膝关节骨关节炎合并膝内翻、胫骨高位截骨的治疗

目的　观察胫骨高位截骨治疗合并内翻畸形的膝关节骨关节炎 (OA)近、远期疗效 ,确定远期良好疗效的最佳下肢力线及术后各不同阶段的临床效果。方法　术前对所有手术患者进行临床X线检查的综合评估 ,测量全下肢立位力线 ,确定矫正截骨角度 ,采用胫骨高位楔形截骨术矫正下肢力线 ,术后 1年、2年、5～ 9年按同一评估标准进行追踪观察。资料应用 χ2检验分析。 结果　随访结果参考窦宝信标准进行综合评定 ,术后 1年组优良率 98.2 8% ,2年组优良率 96 .0 8% ,5～ 9年组优良率 78.12 % ,手术最佳下肢力线为 182°～ 185°。结论　全下肢立位力线测量准确性高 ,可重复性好 ,胫骨高位楔形截骨术矫正下肢力线治疗合并内翻畸形的膝关节OA ,矫正角度易于掌握 ,截骨部位愈合好 ,近、远期疗效高 ,是单侧股 -胫关节病变为主的膝关节OA患者首选的治疗方法。     

距下关节对下肢畸形的代偿作用

正全膝关节置换术(total knee arthroplasty,TKA)后假体生存率与下肢力线的精准重建密切相关,正确评价下肢力线对下肢畸形的矫形手术是非常重要的。许多研究只评估冠状面髋-膝-踝中心轴对线,由于距下关节(subtalar joint,STJ)也承担肢体的重量,为了更好的测量下肢力线,除了评估髋-膝-踝中心轴对线外,也有必要评估STJ的对线[1-3]。STJ是距骨与跟骨间的关节,由距骨下面与跟骨上面的关节面构成,STJ能够     

三维测量技术在眼周软组织定量分析的研究进展

近年来三维测量技术发展迅速,在眼周组织的弧度、凸度、体积形态测量以及眼部动态可视化分析等方面的研究逐渐增多。通过三维成像技术能构建精确的面部3D模型,可以对眼周软组织的面积、体积等指标进行定量分析,为眼部美学评估、手术模拟等提供了精确的方法,展现出了较好的应用价值。现就三维测量技术在眼周区域软组织定量分析的研究进展作一综述。     

数字技术在个性化全膝关节置换股骨轴向力线控制中的应用

目的 应用数字技术设计＂术中股骨外翻角＂来指导全膝关节置换中股骨远端截骨,以期获得良好的股骨轴向力线.方法自2012 年3月至2013 年 7 月收治膝骨关节炎患者共 26例（28 膝）,男 11 例（13 膝）,女15例（15 膝）,年龄58～85岁,平均70.1岁,在术前CT扫描其双下肢,用Mimics软件建立并获得患肢股骨的三维模型.在三维模型中根据下肢轴向力线的定义,模拟术中截骨定位杆的使用确定定位杆在股骨髁的进针点及精确测量出＂术中股骨外翻角＂,在关节置换术中精确复制该过程进行股骨远端的截骨.术后拍摄下肢全长正位片,测量术后股骨机械轴和股骨假体下缘连线的夹角来验证股骨轴向力线的准确性.结果 26例患者（28膝）均行术前设计,测量＂术中股骨外翻角＂平均为（5.67°±1.82°）（3.25°～9.36°）,术中均能很顺利的找到髓内定位杆进针点并进行手术,术后摄片测量股骨机械轴和股骨假体下缘连线的夹角为（90.9°±1.84°）（87.1°～92.8°）.结论 参照数字技术设计的＂术中股骨外翻角＂进行截骨可以很好地控制术后下肢股骨侧的轴向力线,有利于更加精确的进行个性化手术.     

下肢负重位全长X线片在全膝关节置换术前准备中的价值

目的 评价全膝关节置换术(TKA)术前下肢负重位全长X线摄片对术后下肢力线重建及膝关节功能的影响.方法 回顾性收集我院TKA患者共138例,男58例,女80例,平均年龄71.6岁.术前分段摄片组66例,负重位全长摄片组72例.两组患者年龄、性别、体重指数、术前膝关节原发疾病和美国膝关节协会(AKS)膝关节功能评分均无显著差别(P＞0.05),均在术前进行力线分析和矫形设计,术中所有患者均不置换髌骨.两组患者至少6个月随访,比较下肢力线重建和美国膝关节协会(AKS)膝关节功能评分.结果 分段摄片组和负重位全长摄片组术后随访显示,AKS膝关节功能评分和并发症发生率无显著差别(P＞0.05).分段摄片组有4例术后下肢残留畸形大于3°,负重位全长摄片组没有残留畸形大于3°病例(P＜0.05).结论 TKA术前下肢负重位全长摄片有利于全面了解下肢冠状位力线并进行手术设计,从而准确重建下肢力线,故推荐在TKA术前常规应用.     

下肢力线的X线测量及影响因素

下肢力线的测量对疾病的诊断、治疗,预后判断、康复有极其重要的意义,特别是在下肢的矫形外科手术中如下肢延长术、膝内外翻矫正术及髋膝关节置换术,尤其重要。许多研究认为,全膝关节置换(total knee arthrop lasty,TKA)假体的使用寿命在某种程度上取决于术后下肢力线是否合适。然而,临床上往往忽视下肢力线的准确测量与评价而仅做粗略评估。本文就下肢力线X线片测量的有关问题进行综述。1有关概念及常用参考值下肢力线X线测量是指通过一定方法,利用X线片影像,测量下肢的长度、角度等各个力学参数,对比正常和畸形的差异,为临床和科研工作…     

Three-dimensional CT of the genitourinary tract

The applications of three-dimensional (3D) CT techniques encompass a spectrum from calculus disease to preoperative planning. With proper selection of display windows and levels, accurate measurement of stone size can be achieved, along with volumetric information. A CT scan with reconstruction may help guide the direction of an endopyelotomy incision away from crossing vessels. The benefits of 3D CT in the evaluation of living renal donors include lower cost and decreased patient morbidity. In renal allograft recipients and other patients, the study may be used to investigate hypertension. Also, 3D CT is invaluable in planning nephron-sparing surgery for renal masses. The ultimate role of this modality rests in the hands of clinicians who can benefit from them and the radiologists who must provide the high-quality images and the interpretive expertise.     

Musculoskeletal imaging in progress: The EOS imaging system

The EOS 2D/3D radio-imaging device (Biospace med, France) can disclose a digital radiographic image of bones with a very low radiation dose. This in turn allows in obtaining a single image of a large field of view, as wide as the full skeleton. The simultaneous capturing of spatially paired AP and lateral X-ray images is also a specificity of EOS imaging, which further provides secondary 3D (volumic) reformation of skeletal images. The main indications of this new imaging technology are assessment and follow-up of balance disorders of the spine and of the lower limbs.     

EOS Imaging is Accurate and Reproducible for Preoperative Total Hip Arthroplasty Templating

BackgroundTemplating is a critical part of preoperative planning for total hip arthroplasty (THA). The accuracy of templating on images acquired with EOS is unknown. This study sought to compare the accuracy and reproducibility of templating for THA using EOS imaging to conventional digital radiographs.MethodsForty-three consecutive primary unilateral THAs were retrospectively templated, six months postoperatively, using preoperative 2D EOS imaging and conventional radiographs. Two blinded observers templated each case for acetabular and femoral component size and femoral offset. The retrospectively templated sizes were compared to the sizes selected during surgery. Interobserver agreement was calculated, and the influence of demographic variables was explored.ResultsEOS templating predicted the exact acetabular and femoral size in 71% and 66% of cases, respectively, and to within one size in 98% of cases. The acetabular and femoral component size was more likely to be templated to the exact size using EOS compared to conventional imaging (P < .05). The femoral component offset choice was accurately predicted in 83% of EOS cases compared to 80% of conventional templates (P = .341). Component size and offset were not influenced by patient age, gender, laterality, or BMI. Interobserver agreement was excellent for acetabular (Cronbach’s alpha = 0.94) and femoral (Cronbach’s alpha = 0.96) component size.ConclusionsPreoperative templating for THA using EOS imaging is accurate, with an excellent interobserver agreement. EOS exposes patients to less radiation than traditional radiographs, and its three-dimensional applications should be explored as they may further enhance preoperative plans.     

Three-Dimensional Volumetric Analysis of Venous Malformations for Assessing the Effectiveness of Percutaneous Sclerotherapy

BACKGROUNDPercutaneous sclerotherapy can be used to successfully treat venous malformations (VMs) of the head, neck, and limbs. However, the standard curative effect of sclerotherapy has rarely been analyzed, and there is currently no accurate statistical method to measure the volume of VMs after sclerotherapy. Here, we propose a novel three-dimensional (3D) reconstruction method to evaluate this effect.OBJECTIVETo test the feasibility of 3D software (MIMICS 19.0) to evaluate the treatment effect of sclerotherapy.METHODSThis retrospective study included patients with VMs on the head, neck, and limbs who were treated with ethanol sclerotherapy or foam sclerotherapy every 8 weeks. MIMICS 19.0 was used to calculate the performance of the lesion after treatment and measure the VM volumes before and after the treatment. The effect of the clinical treatment dose on the lesion was evaluated, and the treatment effect of each patient was recorded. The relationship between the number of treatments and the reduced volume of VMs was analyzed.RESULTSBased on the MIMICS-calculated regions of interest (ROI), we found that 1 mL of ethanol reduced the lesion by 473 mm³ and that one dosage of foam (1 mL of polidocanol and 4 mL air content) reduced the lesion by 2 138 mm³, demonstrating that the foam sclerosing agent exhibited greater efficacy in this study.CONCLUSIONSThe MIMICS 3D volume reconstruction method can effectively and safely evaluate the efficacy of sclerotherapy and provide a preoperative evaluation. This method is simple, accurate, and feasible.     

Breakthrough in three-dimensional scoliosis diagnosis: significance of horizontal plane view and vertebra vectors

Scoliosis is a multifactorial three-dimensional (3D) spinal deformity with integral and directly related vertebral deviations in the coronal, sagittal and horizontal planes. Current classification and diagnostic methods rely on two-dimensional (2D) frontal and lateral X-ray images; no routine methods are available for the visualization and quantitative evaluation of deviations in the horizontal plane. The EOS 2D/3D system presented here is a new, low-dose, orthopedic radiodiagnostic device based on Nobel prize-winning X-ray detection technology with special software for 3D surface reconstruction capabilities that finally led to a breakthrough in scoliosis diagnosis with high-quality, realistic 3D visualization and accurate quantitative parametric analysis. A new concept introducing vertebra vectors and vertebra vector parametric calculations is introduced that furnishes simplified visual and intelligible mathematical information facilitating interpretation of EOS 2D/3D data, especially with regard to the horizontal plane top view images. The concept is demonstrated by a reported scoliotic case that was readily characterized through information derived from vertebra vectors alone, supplemented with the current angulation measurement methods in the coronal and sagittal planes and axial vertebral rotation measurements in the horizontal plane, with a calibrated 3D coordinate system suitable for inter-individual comparisons. The new concept of vertebra vectors may serve as a basis for a truly 3D classification of scoliosis.     

计算机辅助三维重建技术在颌面部外伤诊治中的应用研究

目的:探讨计算机辅助三维重建技术在颌面部外伤中的诊断及临床应用价值。方法:收集70例颌面部外伤患者。对所有颌面部外伤患者均行普通X线片拍摄、螺旋CT二维扫描和三维重建成像,对结果进行对比分析,并总结三维重建技术在颌面部外伤的临床应用特点。结果:计算机辅助三维成像技术,对70例颌面部外伤患者诊断准确性高,并且能够立体清晰地显示了颌面部骨折部位、类型、骨折块移位情况及颌面部立体形态改变。结论:计算机辅助三维重建技术获得的图像弥补了普通X线及二维CT轴位图像不足,可以全面立体地显示病变,在颌面部外伤的术前诊断、手术计划制定及手术后效果评价中具有重要临床应用价值,可作为常规的影像学检查方法,也是口腔计算机辅助外科的数据基础。     

Use of EOS imaging for the assessment of scoliosis deformities: application to postoperative 3D quantitative analysis of the trunk

European Spine Journal - EOS imaging system is accessible to clinicians since 2007, allowing 3D spinal reconstructions in a functional standing position with reduced radiation. However, numerous...     

Computed tomography assessment of thoracic aortic pathology

Computed tomography technology has improved dramatically in the past decade and now constitutes the backbone of preoperative evaluation for aortic disease. Image acquisition is accomplished with multi-row detectors, and coupled with new reconstruction algorithms provide clinicians with high-resolution images that can be visualized in synch with the cardiac cycle, or as complex three-dimensional renditions of in vivo anatomy. Knowledge regarding the means of data acquisition, reconstruction algorithms, and modes of interpretation are critical for the optimal assessment of aortic disease. These issues are increasingly important as endovascular therapy becomes more commonplace for the treatment of thoracic aortic lesions.     

数字骨科三维可视化技术在肱骨近端粉碎性骨折术前规划中的应用

目的探讨三维可视化技术在肱骨近端粉碎性骨折分型及制定术前计划中的价值。方法将2011年9月～2012年6月间我院收治的临床肱骨近端粉碎性骨折患者15例CT扫描图像数据导入Mimics10.01软件,三维重建肱骨近端粉碎性骨折可视模型,并进行骨折分类。选取肱骨近端粉碎性骨折三维模型进行三维数据测量、复位手术的初步计算机模拟、立体显示。结果重建的肱骨近端粉碎性骨折三维可视模型可准确反映出骨折特点、骨折移位的方向和程度,并可进行任意旋转观察,初步实现了肱骨近端粉碎性骨折术前手术设计、手术的模拟及三维数据测量。本组15例均获随访,随访时间5～18个月。骨折愈合时间平均(27.47±2.69)周;肩关节功能按Constant评分标准评价,平均为88.67±5.15。结论 Mimics软件重建的肱骨近端三维骨折模型可清楚显示骨折情况并明确分型,为术前的手术设计、复位的模拟、内植物选择、三维数据测量等提供了依据。     

Overview of digital breast tomosynthesis: Clinical cases,benefits and disadvantages

In France, the national breast cancer-screening program is based on mammography combined with clinical breast examination, and sometimes breast ultrasound for patients with high breast density. Digital breast tomosynthesis is a currently assessed 3D imaging technique in which angular projections of the stationary compressed breast are acquired automatically. When combined with mammography, clinicians can review both conventional (2D) as well as three-dimensional (3D) data. The purpose of this article is to review recent reports on this new breast imaging technique and complements this information with our personal experience. The main advantages of tomosynthesis are that it facilitates the detection and characterization of breast lesions, as well as the diagnosis of occult lesions in dense breasts. However, to do this, patients are exposed to higher levels of radiation than with 2D mammography. In France, the indications for tomosynthesis and its use in breast cancer-screening (individual and organized) are yet to be defined, as is its role in the diagnosis and staging of breast cancer (multiple lesions). Further studies assessing in particular the combined reconstruction of the 2D view using 3D tomosynthesis data acquired during a single breast compression event, and therefore reducing patient exposure to radiation, are expected to provide valuable insight.