3D打印手术导板在膝关节内外翻畸形患者全膝关节置换中的应用  

Application of three-dimensional printing guide plate in total knee arthroplasty for patients with varus and valgus deformity

作　　者：黄辰宇 唐成[1,2,3] 魏波 李佳怡[1,2,3] 李旭祥 张惠康[2,3] 徐燕 姚庆强 王黎明 Huang Chenyu;Tang Cheng;Wei Bo;Li Jiayi;Li Xuxiang;Zhang Huikang;Xu Yan;Yao Qingqiang;Wang Liming(Department of Orthopedics,Nanjing Hospital Affiliated to Nanjing Medical University,Nanjing 210006,Jiangsu Province,China;Institute of Digital Medicine,Nanjing Medical University,Nanjing 210006,Jiangsu Province,China;Jiangsu Digital Medicine and 3D printing Clinical Engineering Research Center,Nanjing 210006,Jiangsu Province,China)

机构地区：[1]南京医科大学附属南京医院骨科,江苏省南京市210006 [2]南京医科大学数字医学研究所,江苏省南京市210006 [3]江苏省数字医学与3D打印临床工程研究中心,江苏省南京市210006

出　　处：《中国组织工程研究》2021年第18期2789-2793,共5页Chinese Journal of Tissue Engineering Research

基　　金：江苏省科技项目(BE2019679),项目负责人:王黎明;南京市科技发展计划(201805001),项目负责人:王黎明;国家自然科学基金(81972042),项目负责人:王黎明。

摘　　要：背景:近年来3D打印技术在导航骨折内固定植入、脊柱外科螺钉置入及巨大骨缺损修复重建领域应用较为广泛,但是将3D打印导航模板运用于膝关节内外翻患者全膝关节置换手术的相关报道较少。目的:对比3D打印手术导板辅助全膝关节置换和传统全膝关节置换治疗膝关节内外翻骨性关节炎的效果。方法:选择2019年1月至2020年2月南京医科大学附属南京医院收治的膝关节内外翻骨性关节炎患者39例,其中女18例,男21例,年龄55-83岁,随机分2组:试验组(n=20)在3D打印手术导板辅助下进行全膝关节置换,对照组(n=19)进行传统的全膝关节置换。术后拍摄X射线片,测量冠状面胫骨组件角、矢状面胫骨组件角、冠状面股骨组件角、矢状面股骨组件角、髋膝踝角度及下肢力线角度;记录两组住院时间、手术时间、术中出血量和术后引流量。术后1 d、1周、2周、1个月、3个月时,进行目测类比评分及美国膝关节协会(KSS)评分。试验通过南京医科大学附属南京医院伦理委员会批准。结果与结论:①两组术后的冠状面胫骨组件角、矢状面胫骨组件角、冠状面股骨组件角、矢状面股骨组件角及髋膝踝角度偏移值均<3°,试验组对下肢力线角度的调整效果优于对照组(P<0.05);②试验组的手术时间、术中出血量与术后引流量少于对照组(P<0.05),两组患者住院时间比较差异无显著性意义(P>0.05);③试验组术后1 d、1周的目测类比评分低于对照组(P<0.05),KSS评分高于对照组(P<0.05);④结果表明,对于膝关节严重内外翻患者,3D打印手术导板辅助下的膝关节置换提高了手术精度,节省了术中时间。BACKGROUND:In recent years,three-dimensional(3D)printing technology has been widely used in the fields of navigation fracture internal fixation,spinal screw implantation and huge bone defect repair and reconstruction.However,there are few reports on the application of 3D printing navigation template in total knee arthroplasty for patients with varus and valgus knee joint.OBJECTIVE:To compare the effect of 3D printing surgical guide plate assisted total knee arthroplasty and traditional total knee arthroplasty in the treatment of knee varus and valgus osteoarthritis.METHODS:Totally 39 patients with knee osteoarthritis were selected in Nanjing Hospital Affiliated to Nanjing Medical University from January 2019 to February 2020,including 18 females,21 males,aged 55-83 years old,and randomly divided into two groups.Patients in the trial group(n=20)underwent total knee arthroplasty with 3D printing guide plate.Patients in the control group(n=19)underwent traditional total knee arthroplasty.X-ray films were taken after operation to measure the coronal tibial component angle,sagittal tibial component angle,coronal femoral component angle,sagittal femoral component angle,hip-knee-ankle angle,and angle of lower limb force line.The hospitalization time,operation time,intraoperative blood loss,and postoperative drainage volume were recorded in both groups.Visual analogue scores and American knee society knee scores were performed at 1 day,1 week,2 weeks,1 month and 3 months after operation.The trial was approved by the Ethics Committee of Nanjing Hospital Affiliated to Nanjing Medical University.RESULTS AND CONCLUSION:(1)The deviation values of coronal tibial component angle,sagittal tibial component angle,coronal femoral component angle,sagittal femoral component angle and hip-knee-ankle angle in the two groups were all<3°,and the adjustment effect of the trial group on the angle of lower limb force line was better than that of the control group(P<0.05).(2)The operation time,intraoperative blood loss and postoperative dra

关 键 词：骨 植入物 假体 3D打印导板 全膝关节置换 内外翻畸形 骨关节炎 

分 类 号：R459.9[医药卫生—治疗学] R319[医药卫生—临床医学]