个性化截骨导板辅助TKA治疗膝骨性关节炎并关节外翻畸形  

Patient specific instrumentation assisted primary knee replacement for knee osteoarthritis accompanied with extra-articular deformity

作　　者：骆晓飞[1] 宋树春[1] 魏瑄[1] 王少华[1] 王金良[1] 李哲[1] LUO Xiao-fei;SONG Shu-chun;WEI Xuan;WANG Shao-hua;WANG Jin-liang;LI Zhe(The Second Department of Joint Surgery,Zhengzhou Orthopedics Hospital,Zhengzhou 450046,China)

机构地区：[1]郑州市骨科医院关节病二科,450052

出　　处：《中国矫形外科杂志》2020年第13期1227-1230,共4页Orthopedic Journal of China

摘　　要：[目的]介绍个性化截骨导板辅助一期全膝关节置换治疗膝关节骨性关节炎合并关节外畸形的技术与初步临床结果。[方法]2013年3月~2018年6月采用个性化截骨导板辅助全膝关节置换一期手术治疗膝关节骨性关节炎合并关节外畸形患者31例。术前对全下肢行薄层(0.5 mm)CT扫描,重建下肢全长3D影像,设计出截骨平面和截骨厚度,预测假体型号,3-D打印出尼龙材料个体化截骨导板备用。术中在个体化截骨导板引导下进行截骨,安装假体。[结果]31例患者均顺利完成手术,术中无严重并发症。术后随访12~63个月,平均(37.35±2.61)个月。ROM由术前(83.26±4.13)°增加至末次随访时(97.22±7.81)°。HSS评分从(54.88±6.16)分提高到(85.39±8.93)分。VAS评分由术前(6.86±0.53)分下降至(2.15±0.34)分。影像方面,31例患者冠状位下肢机械轴偏移角度由术前(16.17±5.73)°纠正至(2.93±0.58)°。未见假体松动等不良征象。[结论]在个性化截骨导板辅助下,通过关节内代偿截骨结合软组织平衡技术一期完成全膝关节置换,能够很好恢复下肢机械轴线,获得满意的疗效。[Objective]To introduce the technique and primary clinical outcomes of patient specific instrumentation assisted primary total knee arthroplasty(TKA)for knee osteoarthritis complicated with extra-articular deformity.[Methods]From March 2013 to June 2018,a total of 31 patients underwent primary TKA under assistance of personalized femoral guider for knee osteoarthritis accompanied with extra-articular deformity.Based on the 3 D images of the total femur created by preoperative reinforcement CT slice scanning,the level,angle and thickness of femoral osteotomy was designed,and the size of the femoral prosthesis was selected,and then the real femoral guiders was made by 3 D printing with nylon material.During operation,distal femoral osteotomy was performed under navigation with the personalized femoral guiders,followed by installation of the preselected femoral components.[Results]All patients had primary TKA performed successfully with no serious intraoperative complication,and were followed up for 12 to 63 months with an average of(37.35±2.61)months.The knee ROM significantly increased from(83.26±4.13)°before operation to(97.22±7.81)°at the latest follow up,and the HSS score significantly increased from(54.88±6.16)to(85.39±8.93),whereas the VAS score significantly decreased from(6.86±0.53)to(2.15±0.34).In term of radiographic assessment,mechanical axial in coronal plane was significantly corrected from(16.17±5.73)°preoperatively to(2.93±0.58)°at the latest check.No adverse signs,such as prosthetic loosening,were found in anyone of them to the latest follow-up.[Conclusion]This TKA with intraarticular compensative osteotomy under assistance of personalized femoral guider combined with soft tissue balancing does achieve satisfactory clinical outcomes with proper recovery of the mechanical alignment of the extremity.

关 键 词：全膝关节置换 膝关节骨性关节炎 关节外畸形 患者特异性工具 

分 类 号：R687.4[医药卫生—骨科学]