摘要目的:探讨医工交互在3D打印手术导向器辅助膝关节置换术前规划中的作用。方法:回顾性分析北京大学国际医院骨科部自2018年6月至2022年8月收治的178例3D打印手术导向器辅助膝关节置换手术病例的资料，男29例、女149例；年龄（68.4±6.2）岁（范围53~86岁）；左侧93膝，右侧109膝。骨关节炎171例193膝，类风湿关节炎7例9膝。膝内翻194膝，膝外翻8膝。利用术前规划方案文件资料，描述性分析从工程师交付初始规划方案开始，经过医工交互讨论和调整，直至最终由医生确定手术规划方案为止，记录手术规划方案的调整次数、调整参数种类以及相应的调整原因。结果:202膝手术规划方案的制定均经过至少一轮的医工交互讨论，117膝（57.9%）经讨论后进行了调整，1次调整者100膝（49.5%），2次调整者10膝（5.0%），3次调整者5膝（2.5%），调整最多达4次（2膝，0.9%）；余85膝（42.1%）经讨论后手术医生直接同意工程师的初始规划方案。106膝（52.5%）对股骨侧参数进行了调整，57膝（28.2%）对胫骨侧参数进行了调整，其中46膝（22.8%）同时调整了股骨侧参数和胫骨侧参数。调整最多的参数为股骨后髁截骨厚度（94膝，80.3%）。调整参数的主要原因为：（1）股骨髁左右径和前后径不匹配；（2）胫骨近端扭曲畸形；（3）膝关节严重屈曲挛缩畸形；（4）胫骨平台内侧或外侧存在塌陷；（5）股骨前弓畸形。结论:医工交互在个体化膝关节置换手术中具有非常重要的作用。通过良好的医工交互，医生可以更精确、立体地分析每例患者的解剖特点和病理改变，制定个体化的手术方案。

abstractsObjective:To investigate the significance and importance of the interaction between surgeons and engineers during the preoperative planning phase of total knee arthroplasty (TKA) when utilizing patient-specific instrumentation (PSI).Methods:A retrospective review was conducted on 202 knees of PSI-assisted TKA performed on 178 patients between June 2018 and August 2022. The patients' mean age was 68.4±6.2 years, ranging from 53 to 86 years. Among the participants, there were 149 females and 29 males, 93 left knees and 109 right knees. The study involved 171 patients of osteoarthritis (193 knees) and 7 patients of rheumatoid arthritis (9 knees), with 194 knees presenting varus knees and 8 knees with valgus knees. The preoperative plan documents, from the initial engineer-designed plan to the final plan approved by the surgeon, were analyzed to assess the frequency, parameters, and reasons for adjustments made during the planning process.Results:The planning of the 202 PSI-assisted TKA was subjected to at least one round of surgeon-engineer interaction. Among the 202 TKA planning, 117 knees (57.9%) underwent modifications after discussion, with most plans (100 knees, 49.5%) being confirmed after one round of modification. Two rounds of modifications were performed on 10 knees (5.0%), and three rounds on 5 knees (2.5%). A maximum of four rounds of modifications were made on two knees (0.9%). Furthermore, in the case of the remaining 85 knees (42.1%), the surgeons promptly consented to the engineers' initial planning following the discussions. Specific adjustments were made in 106 knees (52.5%) regarding femoral parameters, 57 knees (28.2%) concerning tibial parameters, and 46 knees (22.8%) requiring adjustments to both femoral and tibial parameters. Notably, the most frequently adjusted parameter was the osteotomy thickness of the posterior femoral condyles, which was modified in 94 knees (80.3%). The reasons for adjusting femoral or tibial parameters were summarized, revealing the main factors as follows: 1) Discrepancy between the mediolateral and anteroposterior diameters of the femoral condyle; 2) Twisted deformity of the proximal tibia; 3) Severe flexion contracture deformity of the knee; 4) Collapse of the medial or lateral tibial plateau; 5) Evident anterior arch deformity of the femur.Conclusion:The interaction between surgeons and engineers plays a pivotal role in the preoperative phase of PSI-assisted TKA. Effective collaboration allows surgeons to accurately analyze the unique anatomical characteristics and pathological changes of each patient in a three-dimensional perspective, facilitating the formulation of individualized surgical plans.