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中华关节外科杂志(电子版) ›› 2020, Vol. 14 ›› Issue (03) : 378 -382. doi: 10.3877/cma.j.issn.1674-134X.2020.03.023

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个案报道

定制3D打印截骨导板辅助胫骨髁外翻截骨术
王加宽1,(), 陈智博1, 王玉欢1, 盛春勇1, 李俊1   
  1. 1. 225002 扬州市妇幼保健院,扬州大学医学院附属医院
  • 收稿日期:2018-12-14 出版日期:2020-06-01
  • 通信作者: 王加宽
  • 基金资助:
    扬州市"十三五"科教强卫工程领军人才(创新团队)(LJRC201823)

Customized three-dimentional printing mold assisted tibial condylar valgus osteotomy in knee osteoarthritis

Jiakuan Wang1(), Zhibo Chen1, Yuhuan Wang1   

  • Received:2018-12-14 Published:2020-06-01
  • Corresponding author: Jiakuan Wang
引用本文:

王加宽, 陈智博, 王玉欢, 盛春勇, 李俊. 定制3D打印截骨导板辅助胫骨髁外翻截骨术[J]. 中华关节外科杂志(电子版), 2020, 14(03): 378-382.

Jiakuan Wang, Zhibo Chen, Yuhuan Wang. Customized three-dimentional printing mold assisted tibial condylar valgus osteotomy in knee osteoarthritis[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2020, 14(03): 378-382.

图1 术前左侧膝关节正侧位X线片,示膝关节退行性变,内侧间隙正常,外侧间隙外宽内窄
图2 术前左侧膝关节CT。图A示左侧膝关节内侧间隙等宽,外侧间隙外宽内窄;图B示左侧股骨外侧髁小于与胫骨外侧髁
图3 术前左侧膝关节MR。图A示膝关节内侧间隙等宽,外侧间隙外宽内窄;图B示后交叉韧带松驰
图4 术前左侧膝关节关节镜表现。图A示股骨内侧髁关节面软骨剥脱;图B示胫骨内侧平台关节面软骨完整
图6 术前模拟截骨的范围、设计个性化截骨导向板。图A为术前模拟截骨部位;图B为术前模拟截骨线;图C为术前模拟设计的截骨导板安放部位正面图;图D为术前模拟设计的截骨导板安放部位侧面图
图7 术前模拟截骨的范围、设计个性化截骨导向板。图A为术前模拟截骨部位;图B为术前模拟截骨线;图C为术前模拟设计的截骨导板安放部位正面图;图D为术前模拟设计的截骨导板安放部位侧面图
图8 3D打印个性化截骨导板。图A为3D打印的截骨导板;图B为3D打印的截骨导板按术前规划截骨面撑开后插入圆棍达到规划的截骨角度
图9 测量截骨的深度图。图A示测量截骨的纵切长度与高度;图B示测量截骨的深度
图10 模拟截骨导向板的固定、截骨。图A模拟截骨导板安放的位置与克氏针固定;图B模拟纵行截骨的部位与深度;图C模拟横行截骨的部位与深度
图11 模拟截骨撑开后的固定。图A模拟截骨导板引导下截骨间隙撑开,克氏针临时固定;图B模拟截骨间隙撑开后移除截骨导板,克针临时固定截骨端
图13 骨刀撑开截骨间隙
图16 术后3月左膝关节X线片。图A~B为左膝关节正侧位X线,示膝关节内外侧间隙等宽,原有的外侧间隙外宽内窄消失;图C为左膝关节下肢全长负重X线,示术后MPTA为90.5°
图15 术中截骨面的撑开固定与钢板安放。图A示导板引导下截骨面撑开,插入圆棍后进行克氏针临时固定;图B示取出截骨导板,安放胫骨内侧锁定钢板;图C为术后即刻C臂X线透视,示截骨位置与撑开与术前规划一致
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