基于3D打印个性化手术导航模板辅助下的人工全膝关节置换

背景：膝关节的解剖形态个体差异显著，而传统膝关节置换手术定位力线方法复杂，不能准确预测术中患者的力线位置、假体大小及截骨量。 目的：探讨基于医学图像三维重建、计算机辅助设计技术以及3D打印制造的个性化手术导航模板辅助下全膝关节置换的临床效果。 方法：采用CT或者磁共振扫描设备对患者进行扫描，获取患者医学图像数据；采用二维医学图像处理技术进行骨骼的三维重构；利用计算机辅助设计技术进行导航模板的设计；采用3D打印技术制造个性化手术导航模板，并进行临床全膝关节置换；置换后采用影像学评估术后效果。 结果与结论：Arigin 3D Pro(昕健医疗技术有限公司)能够准确重构出患者下肢骨骼三维模型，自主研发的三维设计软件Arigin Surgical Templating(昕健医疗)能够精确定位包括下肢力线、股骨旋转轴等在内的下肢相关轴线及截骨参考点。该组研究设计和制作的个性化膝关节手术导航模板，术中和股骨髁与胫骨平台骨性解剖结构贴合紧密，无明显移动；全膝关节置换后患者下肢力线偏差小于3°。 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Total knee arthroplasty based on the assistance of three-dimensional-printing personalized surgical navigation template

BACKGROUND: With significantly individual differences in the anatomy of the knee joint, traditional total knee replacement is difficult to accurately predict the position of locating limb alignment, size of the prosthesis and osteotomy amount of patients during operation. OBJECTIVE: To investigate the clinical effect of total knee replacement based on the assistance of medical image reconstruction, computer-aided design technology and 3D-printing personalized surgical navigation template. METHODS: Medical image data of patients were collected using CT or magnetic resonance scanning equipment. The three-dimensional reconstruction of the bone was conducted by two-dimensional medical image processing technology. The navigation template was designed by computer-aided design technology. The personalized surgical navigation templates were produced by 3D printing technology, and the clinical total knee replacement was conducted. The postoperative results were evaluated using imageology. RESULTS AND CONCLUSION: Arigin 3D Pro (Arigin Medical Co., Ltd.) can accurately reconstruct a three-dimensional model of the lower limb bones. The three-dimensional design software Arigin Surgical Templating by their independent research and development can precisely pinpoint related lower limb axis, including limb alignment, rotation axis of the femur and osteotomy reference point. The personalized navigation template we researched and produced for knee surgery fitted tightly with femoral condyle and tibial plateau bone anatomy during operation,  without significant movement. The deviation of patients’ limb alignment was less than 3° after total knee replacement.