3D打印个性化截骨导板对全膝关节置换术髌骨高度和关节线位置的影响  

Effect of 3D printed patient-specific cutting guide on patellar height and joint line position in total knee arthroplasty

作　　者：王军锋[1] 张继晓 王晓华 袁亮 孙彬 张克[1] 杨滨[1] WANG Junfeng;ZHANG Jixiao;WANG Xiaohua;YUAN Liang;SUN Bin;ZHANG Ke;YANG Bin(Department of Orthopedics,Peking University International Hospital,Beijing,102206;Second Department of Orthopedics,Gucheng County Hospital,Hengshui,Hebei Province,253800,China)

机构地区：[1]北京大学国际医院骨科,北京102206 [2]故城县医院骨二科,河北衡水253800

出　　处：《陆军军医大学学报》2022年第15期1557-1564,共8页Journal of Army Medical University

基　　金：国家自然科学基金青年科学基金(81802233);北京大学国际医院院内科研基金(YN2019ZD05)

摘　　要：目的探讨全膝关节置换术(total knee arthroplasty,TKA)中应用3D打印个性化截骨工具(patient-specific instrumentation,PSI)和传统工具(conventional instrumentation,CI)对患者术后髌骨高度和关节线位置的影响。方法回顾性分析2021年1-10月在北京大学国际医院行初次TKA手术的患者共58例。按术中选用的截骨工具类型,将入组患者分为CI-TKA组(n=22)和PSI-TKA组(n=36),记录并比较两组患者TKA手术前后Insall-Salvati指数、改良Caton-Deschamps(mCD)指数和关节线相对高度的变化。结果在Insall-Salvati指数方面,CI-TKA组术前与术后差值的绝对值为0.11(0.07,0.15),PSI-TKA组术前与术后差值的绝对值为0.06(0.03,0.12),两组在术后Insall-Salvati指数变化上的差异有统计学意义(P<0.05)。在mCD指数方面,CI-TKA组术前与术后差值的绝对值为0.16±0.09,PSI-TKA组术前与术后差值的绝对值为0.08±0.05,两组在术后mCD指数变化上的差异也具有统计学意义(P<0.01)。在关节线高度方面,CI-TKA组患者术前与术后差值的绝对值为2.53(1.64,4.40)mm,PSI-TKA组术前与术后差值的绝对值为2.27(1.53,5.32)mm,两组在术后关节线位置变化上的差异无统计学意义,但两组术后关节线位置均较术前明显升高(P<0.05)。结论使用3D打印个性化截骨工具有助于减小TKA手术对髌骨高度的影响,但在术后关节线位置的保持上与传统工具相比无明显优势。Objective To compare the effect of 3D printed patient-specific instrumentation(PSI)and conventional instrumentation(CI)on the patellar height and joint line position in total knee arthroplasty(TKA).Methods A retrospective case-control study was carried out on 58 patients,who underwent primary TKA in our hospital from January 2021 to October 2021.According to the osteotomy tools selected in TKA,the patients were divided into CI-TKA group and PSI-TKA group.The Insall-Salvati index,modified Caton-Deschamps(mCD)index and relative height of joint line before and after TKA were recorded and compared between the 2 groups.Results In terms of the Insall-Salvati index,the absolute difference between preoperative and postoperative score was 0.11(0.07,0.15)in the CI-TKA group,and 0.06(0.03,0.12)in the PSI-TKA group,and statistical difference was seen in the postoperative index between the 2 groups(P<0.05).Similarly,the absolute difference between preoperative and postoperative mCD index was 0.16±0.09 in the CI-TKA group and 0.08±0.05 in the PSI-TKA group,and obvious difference was also seen in the postoperative difference between them(P<0.01).However,the absolute difference between preoperative and postoperative joint line height was 2.53(1.64,4.40)mm in the CI-TKA group and 2.27(1.53,5.32)mm in the PSI-TKA group.There was no notable difference in postoperative joint line position between the 2 groups,but the position after TKA were significantly higher in both groups than that before TKA(P<0.05).Conclusion The use of 3 D printed PSI can help reduce the impact of TKA on the patella height,but there is no obvious advantage in maintaining the joint line position compared with conventional instrumentation.

关 键 词：全膝关节置换术 个性化截骨导板 髌骨高度 关节线位置 

分 类 号：R687.4[医药卫生—骨科学] R318[医药卫生—外科学]