| Objective: Objective to investigate the accuracy of the digital simulation and 3D printing of the distal femoral cutting guide in artificial TKA,and to predict the accuracy of prosthesis size,so as to provide the basis for the realization of individual and accurate artificial TKA.Methods: 1.18 cases of knee osteoarthritis were selected from Department of orthopedics of Sichuan Provincial People’s Hospital of Sichuan medical science academy from March 2016 to June.There were 9 males and females,with a total of18 knees.The age is 68.6±8.3 years.2.The image data is saved and exported in DICOM format,then use Mimics 16(Materialize Belgium)software for image segmentation and reconstruction of three-dimensional model of distal femur.3.X(LLRs)was used to measure the coronal plane of the femoral mechanical-anatomical angle(FMAA),the lateral femoral angle(LFA),the hip-knee-ankle angle(HKA),and the femorotibial angle;Sagittal plane: the lateral cortex of the distal femur was associated with the anatomical axis(ACA).4.Two different methods were used to locate the anatomical axis of the distal femur,and the angle between the frontal cortex and the anatomical axis was measured by X-ray,and the differences between the two methods were compared,and then the differences between the two dimensional and three-dimensional CT measurements were compared.5.The distal femoral cutting angle and the thickness and the size of the prosthesis were determined by reverse engineering software,utilize the Reverse Engineering and Rapid Prototyping technology to 3D print out individual distal femoral cutting guide with cutting groove,and then rehearsal surgery on the three-dimensional femoral model to evaluate the accuracy of cutting and predict prosthesis size.Results: Digital osteotomy thickness of the medial condyle of the femur is8.8±0.9(mm),actual osteotomy thickness is 8.5±1.2 millimeter;Digital osteotomy thickness of the lateral condyle of the femur is 8.7±1.8 millimeter;Actual osteotomy thickness is 8.7±1.5 millimeter,and there were no statistically significant differences between the thickness of the distal femoral condyle,both of the medial condyle and lateral condyle(P>0.05).Accuracy of prosthesis size is completely in conformity with preoperative prediction of the prosthesis size;X-ray measurement :In the experiment,the angle between the cortex and the anatomical axis is-0.1±1.2 degree,and in the traditional method,the angle is-0.6±0.8 degree,there was no statistically significant differences between the two methods(P > 0.05);Three dimensional anatomical measurements: the angle between the cortex and the anatomical axis is0.2±1.4 degree,there was still no significant difference between the two methods in comparison with the X method(P > 0.05).At lase the posterior condylar angle is3.1±1.0 degree。Conclusion: Digital simulation and 3D Printing technology can be tailored to individual patients based on the model,to provide a more intuitive and comprehensive information on the distal femoral cutting accuracy and high accuracy and predict the size of the prosthesis;preoperative measurements of cortical anatomy and 3D model of line axis angle of approximately 0 degree,and it can be used as traditional manual TKA operation in stock the bone marrow cavity rod insertion guide;Femur surgical epicondylar axis relative to the posterior condylar line external rotation angle is3.1±1.0 degree,so in order to restore good rotational alignment,we recommended preoperative measurement of individual femoral rotation angle.Objective: Objective to evaluate the accuracy and safety of the application of 3D printing to the distal femoral cutting guide in artificial TKA.Methods:1.The subjects were selected from the Department of orthopedics of Sichuan Provincial People’s Hospital from July 2016 to February 2017,who underwent 3D printing cutting guide TKA operation.Male: 9 cases,Female: 11 cases,Age:69.4±8.2years old,and BMI:(24.8±3.7)kg/㎡.Preoperative HSS:58.4±10.9,KSS:43.5 ± 15.5,WOMAC:49.3 ± 7.8,VAS:5.6 ± 1.3,ROM:102.5 ±21.4(°);Prosthesis uses LINK? GEMINI? PS and LINK? GEMINI? MK Ⅱ(LINK,Germany).The control group(Conventional intramedullary cutting guides,CON)were retrospectively selected from the Department of orthopedics of Sichuan Provincial People’s Hospital from September 2014 to December 2016,with LINK knee prosthesis replacement,and preoperative diagnosis was 34 cases of knee osteoarthritis,Male: 12 cases,Female: 22 cases,Age:68.2±6.8years old,BMI:25.3±2.6(kg/㎡).2.The both two groups were measured the full length of the lower limb before and after the operation,including the femoral valgus angle(FMAA),the lateral angle of the femur(LFA),hip knee ankle angle(HKA),the femoral angle(FTA),the femoral mechanical axis and the joint line angle(FFA).3.Operation time,intraoperative blood loss,postoperative drainage volume,blood loss and occult blood loss were recorded in the two groups.4.The patients in the PSI group were followed up for 3 months after operation.The scores of HSS,KSS,and ROM were measured to evaluate the postoperative efficacy.Results: There was no significant difference between the two groups in gender,age,BMI and other general data(P < 0.05);And there was still no significant difference between the two groups in measurement of the lower limb :FMAA,LFA,HKA,FTA before surgery.2.Postoperative measurement of the lower limb in PSI group :FMAA was 7.1±2 degrees,LFA 83.3±2.4 degrees,HKA 179.1±1.3 degrees,FTA 173.6±2degrees,FFA was 88.7±1.4 degrees;CON group :FMAA was 5.9±1.8 degrees, LFA 85.4±2.8 degrees,HKA 179.3±2.2 degrees,FTA 175.5±2.3 degrees,FFA 87.3±3 degrees.The LFA,FTA was statistically significant difference between the two groups(P < 0.05),but the FCA,HKA,FFA had no significant difference(P > 0.05).3.There was no significant difference between preoperative DFFA :1.2±1.7 degrees and postoperative DFFA: 1.6±2.8 degrees.After 3 months of follow-up HSS score was 86.6±8.3 points,KSS score was 77.5±13.4 points,the WOMAC score was12.4±7.9 points,compared with preoperative had statistically significant(P < 0.05),but 3 months after the surgery of knee joint ROM was 110.1±11.6 degrees,compared with the preoperative difference was not statistically significant(P > 0.05).4.In group PSI,the operation time was 112.5±18.6(min),the intraoperative blood loss was73.2±32.7 ML,and the total blood loss was 419.9±211.8ML,and the hidden blood loss was 241.8±237 ML,and the 24 h flow rate was 154.5±127.3ML,with an average reduction of hemoglobin was 1.5±0.8g/DL;In group CON,the operation time was143.1±35.6(min),the intraoperative blood loss was 155.9±109.2 ML,and the total blood loss was 784.0±342.4 ML,and the hidden blood loss was 451.1±351.3ML,the24 h flow rate was 218.1±156.2ML,with an average reduction of hemoglobin was2.7±1.1 g/d L.There was significant difference between the two groups in the operation time,and the amount of blood loss,the total amount of blood loss,the hidden blood loss and the mean reduction of hemoglobin(P < 0.05),but there was no significant difference between the two groups in postoperative 24 h flow(P > 0.05)。Conclusion: 3D printing of distal femoral PSI can significantly improve the lower limb coronal line,and the preoperative simulation software is highly consistent;Can significantly reduce the operation time,intraoperative blood loss and occult blood loss during operation,avoid the pulp caused by trauma;There were no nerves and blood vessels injury during the operation,and no infection or deep venous thrombosis occurred after the operation;The function of knee joint recovered well after 3 months of follow-up.Therefore,the application of clinical utilize of 3D printing of the distal femoral osteotomy guide plate was safety and the accuracy of the lower limb force line correct were higher,and can obtain good clinical effect. |
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