摘要
背景:随着计算机及图像辅助技术的发展,3D打印技术被广泛应用于骨外科手术中,3D打印个性化截骨导板辅助行全膝关节置换术(TKA)具有重建复杂畸形关节、精准定位和截骨等优势。目的:探讨3D打印技术个性化截骨导板辅助TKA治疗膝骨关节炎(KOA)合并关节外畸形患者的临床疗效。方法:前瞻性选取2018年1月至2020年6月收治的KOA合并关节外畸形并行TKA的60例患者,按随机数字表法随机分为3D打印组(n=30)和传统TKA组(n=30)。选取同期30名健康志愿者作为健康对照组。分别记录两组手术患者手术时间和术中出血量。记录两组手术患者术后6个月膝关节屈曲和伸直活动范围、双下肢力线及美国特种外科医院(HSS)评分。同时采用Opt-Knee膝关节三维运动分析系统采集健康对照组及两组手术患者膝关节运动学数据。结果:所有患者均顺利完成手术。与传统TKA组患者比较,3D打印组患者手术时间更短,术中出血量更少,且差异均有统计学意义(P均<0.05)。X线检查结果显示,两组患者假体位置良好,无假体松动和周围组织感染等。术后6个月,3D打印组患者下肢力线角度小于传统TKA组患者,HSS评分高于传统TKA组患者,且差异均有统计学意义(P均<0.05),而两组患者膝关节屈曲和伸直活动范围差异无统计学意义(P>0.05)。术后6个月,3D打印组患者屈伸角、内外翻角与健康对照组比较差异无统计学意义(P均>0.05),而传统TKA组患者屈伸角、内外翻角均小于健康对照组,且差异均有统计学意义(P均<0.05)。结论:3D打印个性化截骨导板辅助TKA治疗KOA合并关节外畸形患者,术后下肢力线重建更为精准,可使患者术后早期获得较好的临床疗效,达到有效的畸形矫正和膝关节功能恢复。
Background:With the development of computer and image-assisted technology,3D printing technology is widely used in orthopedic surgery.3D printing personalized guide plate assisted total knee arthroplasty(TKA)has the advantages of reconstructing complex deformed joints,precise positioning and osteotomy.Objective:To investigate the clinical efficacy of 3D printing personalized guide plate assisted TKA in the treatment of knee osteoarthritis patients with extra-articular deformities.Methods:Sixty patients with knee osteoarthritis and extra-articular deformity treated by TKA between January 2018 and June2020 were enrolled in this prospective study and randomly divided into 3D printing group(n=30)and traditional TKA group(n=30).Operation time and intraoperative blood loss of the two groups were recorded.The knee joint range of motion,both lower limb lines and Hospital for Special Surgery(HSS)score were used to evaluate knee joint function 6 months postoperatively.At the same time,the Opt-Knee three-dimensional motion analysis system was used to collect knee kinematic data of which were compared with those in 30 healthy volunteers(healthy control group).Results:All the patients in the both groups completed the operation successfully.The operation time and intraoperative blood loss in the 3D printing group were significantly less than those in the traditional TKA group(P<0.05).X-ray results showed that the prostheses of the two groups were in good position,no loosening or infection was found.The angle between the femur and tibia mechanical axis of the 3D printing group was significantly smaller than that of the traditional TKA group,while the HSS score was significantly higher than that in the traditional TKA group(P<0.05).There was no significant difference in the flexion-extension angle or valgus angle between 3D printing group and healthy control group(P>0.05).The two angles of the traditional TKA group were significantly lower than those of the healthy control group(P<0.05).Conclusions:3D printing personalized guide plate assisted TKA can achieve more accurate lower limb force line reconstruction,effective deformity correction and knee function recovery and obtain better early clinical results in patients with knee osteoarthritis complicated with extra-articular deformity.
作者
徐饶
刘杰
徐松
王庆伟
杜建伟
XU Rao;LIU Jie;XU Song;WANG Qingwei;DU Jianwei(Department of Orthopaedics,Affiliated Hospital of Yangzhou University,Yangzhou 225001,Jiangsu,China)
出处
《中华骨与关节外科杂志》
2021年第7期600-605,共6页
Chinese Journal of Bone and Joint Surgery
关键词
3D打印技术
全膝关节置换术
膝骨关节炎
关节外畸形
Three-dimensional Printing
Total Knee Arthroplasty
Knee Osteoarthritis
Extra-articular Deformity
