3D打印截骨导板在人工全膝关节置换术中的应用  

Clinical application of 3D printing guild plate in total knee arthroplasty

作　　者：吴东迎[1] 袁峰[1] 吴继彬[1] 吴居泰[1] 赵凤朝[1] 李超[1] 郭开今[1] 

机构地区：[1]徐州医学院附属医院骨科,221000

出　　处：《中华骨科杂志》2015年第9期921-926,共6页Chinese Journal of Orthopaedics

摘　　要：目的评价应用3D打印截骨导板的人工全膝关节置换术的临床疗效及安全性。方法2014年5至9月接受初次单侧全膝关节置换（totalknee arthroplasty，TKA）的患者40例，男11例，女29例；年龄57-82岁，平均（68．5±6．3）岁。随机分为两组，每组20例。一组采用3D打印截骨导板辅助TKA手术（3D导板TKA组），另一组采用常规TKA手术（常规TKA组）。两组患者年龄、性别、侧别的差异均无统计学意义。记录两组出血量（术中出血量＋术后引流量）、手术时间，比较术后2周时美国特种外科医院（Hospitalfor Special Surgery，HSS）膝评分、膝关节活动度及下肢力线的改善情况，评估并发症的发生情况。结果3D导板TKA组手术时间（103．4±11．7）min、常规TKA组（124．5±21．6）min，两组差异有统计学意义（t=3．838，P=0．000）；3D导板TKA组出血量为（370．2±96．0）ml、常规TKA组（510．0±235．9）ml，两组差异有统计学意义（t=2．454，P=0．019）。3D导板TKA组术后2周膝关节活动范围为104．3°±15．5°、常规TKA组103．5°±12．5°，两组差异无统计学意义（t=0．169，P=0．867）；3D导板TKA组术后2周HSS膝评分（88．5±5．7）分，常规TKA组（89．4±4．8）分，两组差异无统计学意义（t=00．633，P=0．530）。3D导板TKA组术后股骨与胫骨机械轴夹角为2．9°±1．1°、常规TKA组3．0°±0．9°，两组差异无统计学意义（t=-0．317，P=0．753）。两组患者均未出现术中和术后并发症。结论应用3D打印截骨导板辅助的TKA手术术后2周膝关节功能、下肢力线和关节活动度的改善与常规TKA手术无异，但手术时间更短、出血量更少。Objective To evaluate the efficacy and safety of total knee arthroplasty （TKA） with 3D printing guild plate by comparing with conventional TKA. Methods From May 2014 to September 2014, 40 patients suffered primary unilateral TKA were received, in which there were 11 males and 29 females, aged from 57 to 82 years with an average age of 68.5±6.3 years. The subjects were divided into two groups randomly. One group was treated with TKA with 3D printing guild plate while the other group was treated with the conventional TKA. The blood loss, operation time, post-operative Hospital for Special Surgery （HSS） score, range of motion （ROM）, lower limb mechanical alignment and incidence of complication were compared with insignificant differences. Results The operation time in the 3D printing TKA group （103.4±11.7 rain） was lower than that in the conventional TKA group （124.5±21.6 min）, which was statistically significant （t=3.838, P=0.000）. The blood loss in the 3D printing TKA group （370.2±96.0 ml） was lower than that in the conventional TKA group （510.0±235.9 ml）, which was statistically significant （t=2.454, P=0.019）. The post-operative ROM of knee in the 3D printing TKA group was 104.3°± 15.5° and that in the conventional TKA group was 103.5°± 12.5° （t=0.169, P=0.867）. HSS scores in the 3D printing TKA group and in the conventional TKA group were 88.5±5.7 and 89.4±4.8, which was statistically insignificant （t=-0.633, P=0.530）. Mechanical alignment in the 3D printing TKA group was 2.9°±1.1° and that in the conventional TKA group was 3.0°±0.9°, which was not statistically significant （t=-0.317, P= 0.753）. No obvious complication occurred in two groups. Conclusion TKA with 3D printing guild plate has similar results to conventional TKA in HSS score, mechanical alignment and ROM of knee, but it shortens operation time and decreases the blood loss.

关 键 词：关节成形术 置换 膝 成像 三维 随机对照试验 

分 类 号：R687.4[医药卫生—骨科学]