分体式3D打印个性化导板在内侧开放楔形胫骨高位截骨术中的临床应用  

Clinical application of split three-dimensional printing patient-specific instrumentation in medial open-wedge high tibial osteotomy

作　　者：高发维 王成功[1,2] 胡懿郃[1,2] 苏士龙 齐军 钟达[1,2] GAO Fawei;WANG Chenggong;HU Yihe;SU Shilong;QI Jun;ZHONG Da(Department of Orthopaedics,Xiangya Hospital,Central South University,Changsha Hunan,410008,P.R.China;Digital Research Institute of Orthopedics,Xiangya Hospital,Central South University,Changsha Hunan,410008,P.R.China)

机构地区：[1]中南大学湘雅医院骨科,长沙410008 [2]中南大学湘雅医院数字骨科研究室,长沙410008

出　　处：《中国修复重建外科杂志》2021年第9期1119-1124,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金资助项目(81974360)。

摘　　要：目的探讨分体式3D打印个性化导板(patient-specific instrumentation,PSI)应用于内侧开放楔形胫骨高位截骨术(medial open-wedge high tibial osteotomy,MOWHTO)的准确性及其治疗膝关节内侧骨关节炎的临床疗效。方法回顾分析2019年8月—2020年8月采用分体式3D打印PSI辅助MOWHTO治疗的14例膝关节内侧骨关节炎患者临床资料。男5例,女9例;年龄43~68岁,平均61岁。病程1~16年,平均4.7年。术前膝骨关节炎Kellgren-Lawrence分级:Ⅰ级2例、Ⅱ级6例、Ⅲ级6例。术前美国特种外科医院(HSS)评分为(59.1±4.9)分。根据术后影像学资料测量下肢负重线比率(weight bearing line ratio,WBL)、髋-膝-踝角(hip-kneeankle angle,HKA)、胫骨近端内侧角(medial proximal tibial angle,MPTA)、胫骨平台后倾角(posterior tibial slope angle,PTSA)及实际矫正角度,并与术前测量值及设计目标值进行比较,评价该导板辅助手术的精确度;分别于术后3、6个月及末次随访时采用HSS评分评估患者膝关节功能。结果1例患者术后2周出现切口渗液,经对症治疗后好转;其余患者切口均Ⅰ期愈合。14例患者均获随访,随访时间7~19个月,平均14.8个月,未出现神经损伤、合页骨折、钢板螺钉断裂及松动等并发症,随访期间X线片示WBL基本维持在术后水平。患者术后测量WBL、HKA、MPTA、PTSA均在满意范围内,术后WBL、HKA、MPTA均较术前显著改善(P<0.05),PTSA与术前比较差异无统计学意义(P>0.05);术后WBL、HKA、MPTA、矫正角度与术前设计目标值比较差异均无统计学意义(P>0.05)。术后3、6个月及末次随访时HSS评分分别为(69.2±4.7)、(77.7±4.3)、(88.1±5.4)分,均较术前提高,手术前后各时间点间比较差异均有统计学意义(P<0.05)。结论对于膝关节内侧骨关节炎患者,在MOWHTO中应用分体式3D打印PSI可辅助术者精准截骨矫形,获得良好临床效果。Objective To investigate the accuracy of split three-dimensional(3D)printing patient-specific instrumentation(PSI)in medial open-wedge high tibial osteotomy(MOWHTO)and its effectiveness in treating medial knee osteoarthritis.Methods Clinical data of 14 patients with medial knee osteoarthritis and treated with split 3D printing PSI-assisted MOWHTO between August 2019 and August 2020 were retrospectively analyzed.There were 5 males and 9 females with an average age of 61 years(range,43-68 years).The disease duration ranged from 1 to 16 years,with an average of 4.7 years.Preoperative Kellgren-Lawrence grading of knee osteoarthritis included gradeⅠin 2 cases,gradeⅡin 6 cases,and gradeⅢin 6 cases.The Hospital for Special Surgery(HSS)score was 59.1±4.9.The weight bearing line ratio(WBL),hip-knee-ankle angle(HKA),medial proximal tibial angle(MPTA),posterior tibial slope angle(PTSA),and actual correction angle of the lower limbs were measured on postoperative imaging data,and compared with the preoperative measurements and the designed target values to evaluate the accuracy of the PSI-assisted surgery.The patients’knee function were evaluated with the HSS score at 3 and 6 months postoperatively,and at last follow-up.Results One patient suffered from an incision exudation at 2 weeks postoperatively,and the incision healed after symptomatic treatment.The incisions of other patients healed by first intention.All patients were followed up 7-19 months(mean,14.8 months).There was no neural injuries,hinge fracture,plate or screw fractures,loosening,or other complications.The WBL was maintained at the postoperative level according to the X-ray examination during the followup period.The WBL,HKA,MPTA,and PTSA were all within a satisfactory range after operation.The WBL,HKA,and MPTA were significantly improved when compared with the preoperative measurements(P<0.05).There was no significant difference between preoperative and postoperative PTSA(P>0.05).The differences in postoperative WBL,HKA,MPTA,and correction angle comp

关 键 词：胫骨高位截骨术 3D打印 分体式导板 准确性 膝骨关节炎 

分 类 号：R687.3[医药卫生—骨科学]