数字技术在全膝关节置换术股骨旋转控制中的应用

目的 探讨在人工全膝关节置换术（TKA）中采用数字技术进行个体化股骨旋转定位的准确性及可行性。方法 选择上海市东方医院关节外科2012年5月—2013年11月68例膝关节严重退变病例纳入观察组进行回顾性分析，全部病例x线检查均符合Kellgren＆Lawrence分级法Ⅲ级以上，且合并严重的膝关节疼痛及活动受限。术前CT扫描下肢采集数据后利用数字化软件Mimicsl4．01在建立的3D立体模型中测量股骨后髁角，在TKA中参照该角度进行个体化截骨，术后再次测量股骨后髁角。选择2010年9月—2012年10月统一采用外旋3°截骨的62例患者作为对照组。比较两组手术前后股骨后髁角以及股骨假体旋转不良率。结果 观察组68例采用数字技术的患者术前测得股骨后髁角5．14°±1．59°（1．05°-8．26°），术后0．83°±0．44°（0．03°～2．28°）；对照组中62例采用传统技术的患者术前测得股骨后髁角5．47°±1．23°（1．97°-8．41°），术后3．82°±0．41°（0．08°-6．93°）。两组患者术前的股骨后髁角差异无统计学意义（t=1．349，P〉0．05），观察组术后股骨后髁角明显小于对照组，差异有统计学意义（t=39．973，P〈0．01）。观察组股骨假体旋转不良率为10．3％（7／63），对照组为38．7％（24／62），两组比较差异有统计学意义（χ^2=14．420，P〈0．01）。结论 TKA术前应用数字化技术测量股骨后髁角，并根据测量结果进行个体化股骨外旋截骨，可以获得良好的股骨旋转力线。

Feasibility study of personalized femoral prosthesis rotational certification assisted by digital technology in total Knee arthroplasty

Objective To validate the accuracy and feasibility of personalized femoral prosthesis rotational certification assisted by digital technology in total knee arthroplasty（TKA）. Methods From May 2012 to November 2014, 68 patients of severe knee joint degeneration were treated surgically by TKA. Femoral prothesis rotational certification based on the posterior condylar angle （PCA）, which was measured by digital software Mimics 14.01 according to preoperative CT data, could modulate the lateral rotation angle during the surgery. From September 2010 to October 2012, 62 patients who received the standard TKA were set as a control group. All cases had radiographic knee osteoarthritis above grade m according to Kellgren ＆ Lawrence system combined with chronic knee pain and limited range of motion. Subsequently, the multislice spiral CT scan and digital calculation were performed to evaluate the accuracy of the placed prosthesis postoperatively. Results The pre-operative PCA was 5.14° ± 1.59° （ range, 1.05° - 8.26° ） in the digital group and 5.47° ± 1.23°（ range, 1.97° -8.41°） in the control group. There was no significant difference between the two groups preoperatively （ t = 1. 349, P 〉 0. 05 ）. Femoral prosthesis rotation angle was 0.83 °± 0.44° （ range, 0.03 ° - 2.28 ° ） in the digital group and 3.82 ° ± 0.41° （ range,0.08 ° - 6.93 ° ） in the control group. There was significant difference between the two groups （ t = 39. 973, P 〈 0.01 ）. The malrotation rate was 38.7% in the control group, while the digital group was only 10.3%. There was statistic difference between the two groups （ χ^2 = 14. 420, P 〈 0.01 ）. Conclusions Femoral prothesis rotational certification based on the PCA, which is measured by digital software Mimics 14.01 according to preoperative CT data, can lead to a more personalized and accurate total knee arthroplasty.