3D打印技术比经验丰富的外科医生在多韧带膝关节损伤中进行股骨隧道手术更准确

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics Pub Date : 2025-02-06 DOI:10.1002/jeo2.70159

Núria Fernández-Poch, Ferran Fillat-Gomà, Mireia Gamundi, Giovanni Grillo, Christian Yela-Verdú, Sergi Gil-Gonzalez, Xavier Pelfort

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引用次数: 0

摘要

目的目前多韧带膝关节重建的手术方法包括在股骨远端建立几个重建隧道。然而，膝关节有限的骨量增加了隧道收敛的风险。提高隧道方向的准确性可以最大限度地减少解剖重建过程中的隧道碰撞。由于其精度，3d打印患者专用仪器（PSI）在骨科手术中获得了突出地位。本研究的目的是比较PSI与经验丰富的外科医生在坚持推荐的膝关节多韧带损伤角度的情况下钻取股骨内侧和外侧隧道的“徒手”入路的准确性。方法对10例尸体膝关节进行计算机断层扫描（CT），确定股骨外侧副韧带（LCL）、腘肌腱（PT）、内侧副韧带（MCL）和后斜韧带（POL）的解剖附著。使用Materialise Mimics Medical v25.0软件，对每个韧带进行骨隧道的虚拟规划，每个膝盖总共获得四个隧道。为五个膝关节设计了十个psi：五个用于内侧，五个用于外侧。前5个膝关节通过PSI进行手术，其他5个膝关节由经验丰富的外科医生根据术前计划使用徒手钻孔进行手术。通过将术后CT图像与术前CT图像叠加来评估角度偏差和进入点。结果徒手组中位角偏差为22.3°，四分位间距（IQR）为17.6 ~ 25.2°。PSI组在股骨隧道角度偏差方面的准确性显著提高，为5.7°，IQR为4-8.2°（p < 0.001）。与术前计划组相比，徒手组的中位入穴距离为5.5 mm， IQR为2.6 ~ 8.8 mm。PSI组的中位入穴距离为4.2 mm， IQR为3.6-5.7 mm （p = ns）。结论与经验丰富的外科医生进行的徒手技术相比，PSI在平均角度偏差方面表现出更高的准确性。证据等级V级。

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3D printing technology is a more accurate tool than an experienced surgeon in performing femoral bone tunnels in multi-ligament knee injuries

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3D printing technology is a more accurate tool than an experienced surgeon in performing femoral bone tunnels in multi-ligament knee injuries

Purpose

Current surgical methods for multi-ligament knee reconstruction involve the creation of several reconstruction tunnels in the distal femur. However, the limited bone mass in the knee increases the risk of tunnel convergence. Increasing the accuracy of tunnel direction can minimize tunnel collision during anatomical reconstruction. 3D-printed patient-specific instrumentation (PSI) has gained prominence in orthopaedic surgery due to its precision. This study aims to compare the accuracy of PSI with that of the ‘freehand’ approach by an experienced surgeon for drilling the medial and lateral femoral tunnels while adhering to the recommended angulations for multi-ligament knee injuries.

Methods

Ten cadaveric knees underwent computerized tomography (CT) scans to identify anatomical femoral attachments of the lateral collateral ligament (LCL), popliteal tendon (PT), medial collateral ligament (MCL) and posterior oblique ligament (POL). Using Materialise Mimics Medical v25.0 software, virtual planning of a bone tunnel for each ligament was performed, and a total of four tunnels per knee were obtained. Ten PSIs were designed for five knees: five for the medial side and five for the lateral side. The first five knees were operated on via PSI, and the other five knees were operated on by an experienced surgeon using freehand drilling based on preoperative plans. The angular deviation and entry point were assessed by overlaying post-operative CT images onto preoperative CT images.

Results

In the freehand group, the median angular deviation was 22.3°, with an interquartile range (IQR) of 17.6–25.2°. The PSI group presented a significantly greater accuracy in angular deviation for femoral tunnels of 5.7°, with an IQR of 4–8.2° (p < 0.001). Compared with that in the preoperative planning group, the median entry point distance in the freehand group was 5.5 mm, with an IQR of 2.6–8.8 mm. The PSI group had a median entry point distance of 4.2 mm, with an IQR of 3.6–5.7 mm (p = n.s).

Conclusions

Compared with the freehand technique performed by an experienced surgeon, PSI demonstrated significantly greater accuracy in terms of the mean angular deviation.