上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

数字化模拟技术应用于全膝关节置换术前假体尺寸预测的临床探讨

张进1， 孙立1， 杨先腾1， 胡如印1， 田家亮1， 韩伟1， 田晓滨1， 王金武2， 戴尅戎2   

  1. 1.贵州省人民医院骨科， 贵阳 550002； 2.上海交通大学 医学院附属第九人民医院骨科， 上海 200011
  • 出版日期:2016-09-28 发布日期:2016-10-31
  • 通讯作者: 王金武， 电子信箱： wangjw@sjtu.edu.cn。 田晓滨， 电子信箱： txb6@vip.163.com。
  • 作者简介:张进（1983—）， 男， 主治医师， 博士； 电子信箱： 271179914@qq.com。
  • 基金资助:

    国家自然科学基金（81560356），上海市卫生系统重要疾病联合攻关项目（2013ZYJB0501），上海市卫生计生系统重要薄弱学科建设项目（2015ZB0404），上海市教育委员会高峰高原学科建设计划（20152224），贵州省科技计划（黔科合SY字[2015]3044）

Clinical investigation of the digital simulation technology in predicting the prosthesis size for total knee arthroplasty

ZHANG Jin1, SUN Li1, YANG Xian-teng1, HU Ru-yin1, TIAN Jia-liang1, HAN Wei1, TIAN Xiao-bin1, WANG Jin-wu2, DAI Ke-rong2   

  1. 1.Department of Orthopaedics, Guizhou Provincial Peoples Hospital, Guiyang 550002, China; 2.Department of Orthopaedics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
  • Online:2016-09-28 Published:2016-10-31
  • Supported by:

    National Natural Science Foundation of China, 81560356; A Joint Research Program for Management of Key Diseases by Shanghai Public Health System, 2013ZYJB0501; Key Developing Disciplines Program of Shanghai Health System, 2015ZB0404; Shanghai Municipal Education Commission—Gaofeng Clinical Medicine Grant Support, 20152224; Projects of Science and Technology of Guizhou Province, SY[2015]3044

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摘要：

目的·比较数字化模拟技术与传统胶片模板在全膝关节置换术前假体尺寸预测方面的优劣性，为人工膝关节微创、良好置换提供依据。方法·选取2015年1—6月行全膝关节置换术患者60例，随机数字表法分为数字化模拟测量组及传统胶片测量组。数字化模拟测量组术前采用数字技术模拟手术截骨及假体置放而选定假体尺寸型号，传统胶片组术前使用传统胶片模板在膝关节X片上进行比对而选定假体尺寸型号。将预测型号与最终手术选择型号对比，相关数据行统计学处理，比较2组预测准确率。结果·数字化模拟测量组股骨假体相差1号者2例，相差2号者1例；传统胶片组相差1号者7例，相差2号者2例；型号测量准确率分别为90.0%和70.0%。数字化模拟测量组胫骨假体相差1号者2例；传统胶片组相差1号者8例，相差2号者2例；型号测量准确率分别为93.3%和66.7%。2组差异均有显著统计学意义。结论·数字化模拟测量技术预测全膝关节置换术假体尺寸精确度较高，可为人工关节置换术前规划、微创置换及术前假体型号准备提供参考。

关键词: 数字化, 全膝关节置换术, 假体尺寸, 预测

Abstract:

Objective·To compare the pros and cons between digital simulation technology and conventional film template in predicting the prosthesis size before total knee arthroplasty (TKA) and provide evidence for perfect minimally invasive TKA. Methods·Sixty patients who underwent TKA from January 2015 to June 2015 were selected and assigned to the digital simulation group (DSG, n=30) and the conventional template group (CTG, n=30) based on a random number table method. In DSG, the prosthesis sizes were predicted by digital simulation of surgery, including osteotomy and placement of the prosthesis. In CTG, the comparisons between the film template and the knee X-ray radiographs were conducted to determine the prosthesis sizes. Predictive sizes and final sizes selected by surgeries were compared. The accuracies of prediction in the two groups were compared through statistical analysis of related data. Results·For the femoral prosthesis size prediction, there were 2 cases with a size difference of 1＃ and 1 case  with a size difference of 2＃ in DSG, and  7 cases with a size difference of 1＃ and 2 cases with a size difference of 2＃ in CTG. The accuracies for predicting femoral prosthesis size were 90.0% and 70.0% in DSG and CTG, respectively. For the tibial prosthesis size prediction, there were 2 cases with a size difference of 1＃ in DSG, and 8 cases with a size difference of 1＃ and 2 cases  with a size difference of 2＃ in CTG. The accuracies for predicting tibial prosthesis size were 93.3% and 66.7% in DSG and CTG, respectively. The differences between two groups were statistically significant. Conclusion·The prediction of prosthesis size with digital simulation technology is more accurate compared with conventional film template. This technology can provide evidence for preoperative planning, minimal invasion, and prosthesis preparation for TKA.

Key words: digital, total knee arthroplasty, prosthesis size, prediction