Résumé
BACKGROUND: The accuracy of acetabular prosthesis placement during total hip arthroplasty has a direct effect on postoperative hip function, stability and service life. Unreasonable placement of the cup may lead to adverse events, so CT imaging should be emphasized. OBJECTIVE: To analyze the differences of acetabular parameters in hip arthroplasty between the horizontal and true pelvic planes on CT images, and to determine the possible impact on surgery outcomes. METHODS: Seventy-two cases of pelvic soft tissue disease were selected. All patients signed the informed consents, and the study was approved by the hospital ethics committee. The anteversion angle, acetabular angle, acetabular depth, acetabular width, femoral head midpoint-acetabular margin angle, abduction angle between the true pelvic plane and the horizontal plane were measured by CT positioning film and its scanning image. CT software was selected to reconstruct the three-dimensional image, and then scanned vertically with the true pelvic plane. The above parameters were measured in the same way. The differences of parameters between left and right acetabulum and two planes were compared by paired t test. Spearman correlation analysis was used to analyze the correlation between the angles between the two reference planes and the difference between the measured parameters. RESULTS AND CONCLUSION: (1) There was no significant difference in the values of the left and right acetabular parameters between the horizontal plane and the true pelvic plane (P > 0.05). (2) The pelvic tilt angle was positively correlated with the femoral head midpoint-acetabular margin angle and the acetabular anteversion angle between the two reference surfaces, and negatively correlated with the acetabular angle and acetabular depth. (3) Our results suggest that during the CT scan of the supine position, the pelvis is accompanied by a rotation condition. The parameters of the true pelvis plane as a reference are inaccurate with the directly measured acetabular parameters. Therefore, attention should be paid to the preparation of the surgical plan before surgery.
Résumé
Objective To study the accuracy of preoperative planning and postoperative satisfaction of prosthesis posi?tion by applying the personal surgical cutting guide (PSCG) to total knee arthroscopy (TKA) based on 3D printing technique. Meth?ods In this randomized study, 20 patients were selected from August 2014 to October 2015, who were randomly divided into two groups. In PSCG group, 4 males and 6 females were enrolled, with a mean age of 70.9±6.69 (from 59 to 78) years. In con?ventional instrumentation group, 2 males and 8 females were enrolled, with a mean age of 69.9 ± 6.35 (from 58 to 77) years. The conventional instrumentation group was treated with conventional TKA, while the PSCG group was treated with personal surgical cutting guides. Then the knee valgus angle of patients, the angle between prosthesis components on the coronal and the sagittal plane of two groups were evaluated. Subsequently the correlation of the actual osteotomy amount, the valgus angle, caster angle, external rotation angle between intra? and preoperative planning were compared in the PSCG group. Results Compared with the ideal value of each angle, the mean deviation of the hip?knee?ankle angle 0.77°±0.51°, frontal femoral compo?nent angle 0.37° ± 0.53° and frontal tibial component angle 0.11° ± 0.24° showed statistically significant difference between two groups (P0.05). The actual osteotomy amount, the valgus angle, caster angle, external rotation angle corre?lated well between intra?and preoperative planning (t=-2.547, 3.864, 0.537,-0.040,-1.290, P>0.05). Conclusion TKA assist?ed by PSCG can make lower extremity alignment and accuracy of prosthesis implantation more accurate compared with convention?al TKA, especially in hip?knee?ankle angle, frontal femoral component angle and frontal tibial component angle.
Résumé
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 col ected 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.