目的 比较在人工膝关节双间室置换手术中使用个性化定制3D打印截骨导板与传统标准化截骨工具的临床效果.方法 以2023年3月-2023年5月新疆维吾尔自治区人民医院骨科中心关节老年病区收治的23例原发性骨关节炎患者为研究对象,其中12例行个性化定制3D打印截骨导板工具(Patient-specific instrumentation,PSI)与11例采用传统标准化截骨工具(Con-ventional instrumentation,CVI)行手术的患者.记录两组患者手术时间、失血量、双下肢及股骨、胫骨假体力线.采用美国特种外科医院膝关节评分(Hospital for special surgery,HSS)和膝关节活动度(Range of motion,ROM)于术前1天及术后3个月、6个月、1年评定两组患者膝关节运动范围和运动程度.记录两组患者术后1年髋-膝-踝角(Hip-knee-ankle angle,HKA)即膝髋踝三中心组成的夹角、冠状面股骨假体角(Frontal femoral component angle,FFC)即股骨假体内外髁的切线与股骨机械轴连线的外侧角、冠状面胫骨假体角(Frontal tibial component angle,FTC)、侧方胫骨假体角(Lateral tibia component angle,LTC),股骨远端外侧角(Lateral distal femur angle,LDFA)即股骨头中心与大粗隆高点连线与股骨机械轴组成的夹角,胫骨近端内侧角(Medial prox-imal tibial angle,MPTA)即胫骨内侧平台切线与股骨机械轴形成的夹角、胫骨后倾角(Posterior tibial slope,PTS)、胫骨机械轴与股骨的夹角(Mechanical axis of tibia and femur of angle,MTFA)的情况.结果 23例患者均顺利完成手术并随访12个月,患者术后复查膝关节正侧位、双下肢全长X线片显示假体安放位置合适,随访期间未出现切口感染、神经血管损伤、膝关节假体松动、骨折等并发症.与CVI组比较,PSI组术后1年HKA增大,HKA、FFC、FTC、LTC、LDFA、MP-TA、PTS、MTFA均减小,差异有统计学意义(P＜0.05).与术前比较,两组术后HHS评分均增大,差异有统计学意义(P＜0.05).结论 个性化定制3D打印截骨导板较传统截骨导板在膝关节双间室置换术更加精准、便捷、安全,可降低手术风险,在临床中具有一定的应用价值.
Study on efficacy of 3D printed osteotomy guide plate and traditional osteotomy tool in total knee arthroplasty
Objective To compare the clinical effect of personalized 3D printed osteotomy guide tool and traditional standardized osteotomy tool in total knee arthroplasty.Methods Taking 23 patients with pri-mary osteoarthritis admitted to the hospital from March 2023 to May 2023 as the research objects,12 of them received personalized 3D printed osteotomy guide tools(patient-specific instrumentation,PSI)and 11 patients undergoing surgery with conventional instrumentation(CVI).Operation time,blood loss,prosthetic strength lines of both lower limbs,femur and tibia were recorded and compared between the 2 groups.The Hospital for Special Surgery(HSS)and Range of Motion(ROM)were used to evaluate the range of motion and degree of motion of the knee joints in two groups of patients on 1 day before surgery and at 3,6 months and 1 year after surgery.The Hip-knee-ankle angle(HKA),which is the angle formed by the three centers of knee,hip and ankle,as well as the frontal femoral component angle(FFC),which is the lateral angle of the connection between the tangential line of the external condyle in the femoral pros-thesis and the mechanical axis of the femur,the frontal tibial component angle(FTC),and the lateral tibia component angle(LTC),the lateral distal femur angle(LDFA)was the angle composed of the connection between the center of the femoral head and the high point of the greater trochanteric and the mechanical axis of the femur,the medial proximal tibial angle(MPTA),mechanical axis of tibia and femur of angle,posterior tibial slope(PTS),and mechanical axis of tibia and femur of angle(MTFA)situation.Results All 23 patients successfully completed the surgery and were followed up for 12 months.Postoperative re-exami-nation of the knee joint and full length X-ray of both lower limbs showed that the placement of the pros-thesis was appropriate.During the follow-up period,there were no complications such as incision infec-tion,neurovascular injury,loosening of the knee joint prosthesis or fractures.Compared with the CVI group,the PSI group had an increase in HKA after 1 year of surgery,while HKA,FFC,FTC,LTC,LD-FA,MPTA,PTS and MTFA was decreased,with statistical significance(P＜0.05).Compared with preoperative,the HHS scores of both groups were increased after surgery,with statistical significance(P＜0.05).Conclusion Personalized 3D printed osteotomy guides are more accurate,convenient,and safe than traditional ones in knee joint double chamber replacement surgery,which can reduce surgical risks and have certain clinical application value.
total knee arthroplasty3D printed osteotomy guide plateperioperative blood loss
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