Bone Morphing: 3D Morphological Data for Total Knee Arthroplasty
Bone Morphing: 3D Morphological Data for Total Knee Arthroplasty
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骨形态：全膝关节置换术的 3D 形态数据
DOI：
10.3109/10929080209146026
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发表时间：
2002
影响因子：
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通讯作者：
Jocelyne Troccaz
中科院分区：
文献类型：
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作者：
Eric Stindel;J. Briard;P. Merloz;S. Plaweski;F. Dubrana;C. Lefèvre;Jocelyne Troccaz
目的：探讨人工全膝关节置换术的临床效果。(TKA)主要取决于外科手术本身的准确性。为了改善最终结果，必须考虑（a）假体相对于机械轴的对齐，以及（B）软组织的平衡。因此，形态数据（如骨骺的形状）和几何数据是必不可少的。我们提出了一种新的方法来执行TKA的基础上形态和几何数据，没有术前图像。材料和方法：全球的方法是基于数字化的点与光学三维定位。对于形态学采集，我们使用一种基于稀疏点数据与3D统计可变形模型的配准的方法。为了建立机械轴，我们使用髋关节中心的运动学方法和踝关节中心的解剖标志的数字化。膝关节中心不是通过膝关节的数字化或运动学来确定的，因为这将是不准确的。手术规划完全依赖于软组织平衡，这是获得良好运动学结果的关键问题。结果：我们已经使用了6个月的随机临床试验，涉及35例患者的日期。对于导航组中可以测量的前11名患者，术后正面对线在180 ± 3°范围内。将在延长的2年研究结束时进行软组织平衡的X线透视评估，以从功能角度评价结果。结论：骨形态学是一种准确、快速、用户友好的方法，可以提供形态学和几何学数据。我们在术中计划步骤中引入了重要的软组织平衡概念，以优化运动学和解剖结构。因此，该方法应被视为基于CT的方法的替代方法。
Objective: The clinical outcome of a total knee arthroplasty. (TKA) is mainly determined by the accuracy of the surgical procedure itself. To improve the final result, one must take into account (a) the alignment of the prosthesis with respect to the mechanical axis, and (b) the balance of the soft tissues. Therefore, morphologic data (such as the shape of the epiphysis) and geometric data are essential. We present a new method for performing TKA based on morphologic and geometric data without preoperative images. Materials and Methods: The global method is based on the digitization of points with an optical 3D localizer. For the morphologic acquisitions, we use a method based on the registration of sparse point data with a 3D statistical deformable model. To build the mechanical axis, we use a kinematics method for the hip center and digitization of anatomical landmarks for the ankle centers. The knee center is not determined by digitization or kinematics of the knee, as this would not be accurate. The surgical planning relies totally on the soft-tissue balance, which is the key issue for a good kinematics result. Results: We have used this system for 6 months in a randomized clinical trial involving 3 5 patients to date. For the first 11 patients that could be measured in the navigation group, the postoperative frontal alignment was within the range of 180 ± 3°. Fluoroscopic assessment of the soft-tissue balancing will be performed at the conclusion of an extended 2-year study to evaluate the results from a functional point of view. Conclusion: Bone Morphing is an accurate, fast, and user-friendly method that can provide morphologic as well as geometric data. We have introduced the important notion of soft-tissue balancing into the intraoperative planning step to optimize the kinematics as well as the anatomy. Therefore, this method should be considered as an alternative to the CT-based method.