3D打印光固化树脂模型在精确评估膝关节损伤及其个体化治疗方案制定中的应用

目的：采用三维（3D）打印光固化树脂模型在体外直观地还原膝关节损伤患者骨及关节面损伤范围及程度，为临床上严重的关节炎患者的诊断及个体化治疗方案的制定提供可靠的依据。方法：选取1例19岁男性创伤性关节炎患者，对患者双下肢进行CT扫描并行三维重建，采用3D打印技术以1：1的比例打印出患侧及健侧膝关节骨的光固化树脂模型；随后对模型进行CT扫描，将其与患者膝关节CT数据共同三维重建，并进行参数测量，应用统计学方法比较2组参数差异，验证模型精确性；通过术前手术模拟进行个体化治疗方案制定，通过模型进一步确定与该患者匹配的假体型号。结果：该模型各项参数与患者膝关节影像学参数比较差异无统计学意义（P>0.05）。术中观察，患者股骨远端、胫骨近端关节面等病损情况与术前3D打印模型高度吻合。所选假体型号匹配，手术时间较同类手术明显缩短，麻醉时间及出血量均有所减少。患者术后短期随访效果良好。结论：3D打印光固化树脂模型具有很高的精确度，可以应用于骨关节炎的辅助诊断和手术模拟，确定更为合理的个体化方案，提高手术疗效。

Application of three-dimensional printing stereolithographic models in precise diagnosis for knee injury and formulation of customized treatment plan

Objective: To visually restore the damage scopes and extents of bone and articular surface of the patients with knee joint injury with three-dimensional(3D) printing stereolithographic models, and to provide the reliable basis for diagnosis of the patients with severe arthritis and formulation of customized treatment plan in clinic.Methods: A male patient with traumatic arthritis aged 19 years old was selected. The computed tomography(CT) data of bilateral lower limbs of the patient was collected, and the 3D reconstruction was performed. The stereolithographic models of the ipsilateral and contralateral knee joint bones of the patient in a ratio of 1:1. The selected parameters were compared by computer between the models and bones, and statistic analysis was completed. Based on the preoperative surgical simulation, the individualized treatment plan was formulated. Through the above processes, the size of prosthesis was determined finally, and the total knee arthroplasty(TKA) was completed.Results: There were no statistical differences in the parameters of knee images between the models and bones(P>0.05). During the operation, the damages of distal femur, proximal tibia, and articular surface were highly consistent with 3D-printed models. The size and shape of prosthesis were matched with the patient's bones. The operation duration and amount of bleeding were decreased. The results of short-term follow-up of the patient were satisfactory.Conclusion: 3D printing stereolithographic model owns high precision. It can be used for assisted diagnosis of osteoarthritis and operation simulation, formulating individualized treatment plan and increasing the efficacy of operation.