个性化三维打印距骨假体治疗塌陷性距骨坏死的早期临床效果分析  

Early clinical efficacy analysis of personalized three-dimensional printing talus prosthesis in the treatment of collapse talus necrosis

作　　者：杨钱冬 陈万 穆米多 张臣科 杨瑷宁 陶旭 谢美明 唐康来 Yang Qiandong;Chen Wan;Mu Miduo;Zhang Chenke;Yang Aining;Tao Xu;Xie Meiming;Tang Kanglai(Orthopaedic Sports Medicine Center,the First Affiliated Hospital to Army Medical University,Chongqing 400038,China)

机构地区：[1]陆军军医大学第一附属医院骨科运动医学中心,重庆400038

出　　处：《中华外科杂志》2021年第6期470-476,共7页Chinese Journal of Surgery

基　　金：国家重点基础研究发展计划(973计划) (2016YFC1100503Y)。

摘　　要：目的探讨个性化三维打印距骨假体治疗塌陷性距骨坏死的早期临床效果。方法回顾性分析2016年3月至2019年8月陆军军医大学第一附属医院骨科运动医学中心收治的8例采用个性化三维打印距骨假体进行假体置换治疗的严重距骨塌陷性坏死患者的临床资料。患者均为男性,平均年龄38.0岁(范围:22~65岁)。左侧距骨塌陷5例,右侧3例,病程29.7周(范围:6~96周)。采集对侧健康距骨骨性CT数据进行镜像设计,采用电子束三维打印技术制备假体。距骨体部假体采用钛合金材料(Ti6Al4V),胫距关节距骨侧关节面假体采用钴铬钼合金材料(Co-Cr-Mo),并对距下关节面进行微孔处理。术前通过数字化三维有限元分析与实体对比,测量假体的解剖匹配性。手术采用踝正中长切口,完整取出塌陷坏死距骨,植入上述假体。患者术后3、6、12个月于门诊复查。收集患者手术前后的踝关节活动范围、影像学数据、疼痛视觉模拟评分和美国足踝外科学会(AOFAS)踝-后足评分及术后足底压力分布相关参数。多次测量资料的比较采用重复测量方差分析,两两比较采用配对样本t检验。结果所有患者的距骨假体解剖结构与对侧健康距骨完全一致,适配性良好,切口均Ⅰ期愈合,无手术相关并发症发生,术后随访23.2个月(范围:12~48个月)。患者术前踝关节背伸角度为(7.6±5.7)°,术后12个月时为(14.2±6.6)°(t=-2.67,P=0.03);术前踝关节跖屈角度为(22.0±9.9)°,术后12个月时为(29.2±8.7)°(t=-8.95,P<0.01)。术前疼痛视觉模拟评分为[M(QR)]3.0(0.8)分,术后3个月为2.5(1.0)分,术后6个月为1.5(1.0)分,术后12个月为1.0(1.0)分(F=20.00,P<0.01)。术前AOFAS踝-后足评分为(26.3±6.6)分,术后3个月为(70.1±2.2)分,术后6个月为(76.0±3.4)分,术后12个月为(79.3±4.2)(F=56.81,P<0.01)。末次随访时,患者影像学检查均示假体位置稳定,无下沉迹象,无需行二期踝关节融合或翻修术,�Object To examine the preliminary clinical efficacy of custom-made three-dimensional(3D)printed talus prosthesis in the treatment of collapse talus necrosis.Methods The clinical data of 8 patients who received 3D printed custom-made talus prostheses replacement for severe collapsed necrosis of the talus at the Orthopaedic Sports Medical Center,the First Affiliated Hospital to Army Medical University were analyzed retrospectively.All patients were male,with an average age of 38.0 years(range:22 to 65 years).There were 5 cases of left talus collapse and 3 cases of right talus collapse,with the course of disease of 29.7 weeks(range:6 to 96 weeks).The CT data of contralateral healthy talus were used for mirror image design references for the prosthesis,and the electron-beam 3D printing technology was used to prepare the prosthesis.Titanium alloy(Ti6Al4V)was taken as the material for the preparation of the talus body prosthesis,and Co-Cr-Mo material was used as the material for the preparation of the tibialis talus lateral joint surface prosthesis,and the subtalar joint surface of the prosthesis was made from a microporous casting technique.The prosthesis was analyzed preoperatively by digital three-dimensional finite element analysis and solid comparison techniques to measure anatomic match of the prosthesis.A longitudinal incision on medial ankle was made.The necrotic talus was completely removed and the prosthesis was then implanted.The patient was reexamined in the outpatient department 3,6,and 12 months after surgery.Primary outcome measures were the American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hind foot score,visual analogue scale(VAS)and ankle range of motion.Changes in imaging data and plantar pressure were also assessed.Repeated measures analysis of variance and paired-t test were used to compare the data.Results The talus prosthesis measure preoperatively was completely consistent with that contralateral healthy talus and there was no operation-related complication.All the wounds healed primarily.

关 键 词：距骨 假体和植入物 足底压力分析 成像 三维 

分 类 号：R687.3[医药卫生—骨科学]