3D打印导板辅助定位与C形臂X线机透视定位股骨隧道重建内侧髌股韧带治疗复发性髌骨脱位的疗效比较  

3D printed guide plate assisted and C‑arm X‑ray fluoroscopic positioning for femoral tunnel reconstruction of medial patellofemoral ligament in treating recurrent patellofemoral dislocation:a comparison of efficacies

作　　者：杨贤光 张艳 李彦林[1] 蔡国锋[1] 余洋[1] 施政良 王国梁[1] Yang Xianguang;Zhang Yan;Li Yanlin;Cai Guofeng;Yu Yang;Shi Zhengliang;Wang Guoliang(Department of Sports Medicine,First Affiliated Hospital of Kunming Medical University,Kunming 650032,China;Department of Postpartum Rehabilitation,First People′s Hospital of Lin′an District,Hangzhou 311399,China)

机构地区：[1]昆明医科大学第一附属医院运动医学科,昆明650032 [2]杭州市临安区第一人民医院产后康复科,杭州311399

出　　处：《中华创伤杂志》2023年第7期583-592,共10页Chinese Journal of Trauma

基　　金：云南省骨关节疾病临床医学中心项目(ZX2019‑03‑04);云南省领军人才项目(L‑201601);云南省重大科技专项计划项目(202102AA100015)。

摘　　要：目的比较3D打印导板辅助定位与C形臂X线机透视定位股骨隧道重建内侧髌股韧带治疗复发性髌骨脱位的疗效。方法采用回顾性队列研究2018年1月至2022年12月昆明医科大学第一附属医院收治的60例复发性髌骨脱位患者的临床资料,其中男29例,女31例;年龄14~40岁[(28.6±7.6)岁]。30例行内侧髌股韧带重建术时使用3D打印导板辅助定位股骨隧道(3D导板组),30例行内侧髌股韧带重建术时使用传统C形臂X线机透视定位股骨隧道(常规透视组)。(1)术后7 d内采集患膝关节CT数据,导入Mimics 19.0软件测量两组患者术后股骨隧道中心至Schöttle点的距离;(2)术前及术后3,6,9,12个月采用膝关节Lysholm评分、Kujala评分评价患者膝关节功能情况;(3)术前及术后3,6,9,12个月通过Opti‑Knee^(TM) 3D膝关节运动学分析系统采集患膝关节的前后位移、上下位移、内外位移、内外翻角、内外旋角及屈伸角,计算各自由度范围并与30名健康人群的该6个自由度进行膝关节运动学分析。结果患者均获随访12~15个月[(12.3±0.7)个月]。(1)术后7 d内所测3D导板组股骨隧道中心至Schöttle点距离为(5.5±2.3)mm,小于常规透视组的(7.6±2.5)mm(P<0.01)。(2)术后3D导板组和常规透视组Lysholm评分、Kujala评分较术前逐渐提高(P均<0.01)。术前、术后12个月3D导板组和常规透视组膝关节Lysholm评分、Kujala评分差异无统计学意义(P均>0.05);术后3,6,9个月3D导板组Lysholm评分[(70.4±4.5)分、(86.4±3.1)分、(91.2±3.2)分]、Kujala评分[(74.2±5.3)分、(80.9±3.5)分、(85.2±3.2)分]高于常规透视组[Lysholm评分:(67.3±5.2)分、(81.8±2.5)分、(86.2±1.9)分;Kujala评分:(69.8±5.2)分、(77.6±2.1)分、(82.7±2.6)分](P<0.05或0.01)。(3)术前3D导板组和常规透视组前后位移[(0.6±0.1)cm、(0.6±0.2)cm]、上下位移[(0.5±0.1)cm、(0.6±0.0)cm]、内外位移[(0.7±0.1)cm、(0.6±0.2)cm]、屈伸角[(50.6±10.3)°、(51.6±8.5)°]小于健�Objective To compare the efficacies of 3D printed guide plate assisted positioning and C‑arm X‑ray machine fluoroscopic positioning for femoral tunnel reconstruction of medial patellofemoral ligament in treating recurrent patellofemoral dislocation.Methods A retrospective cohort study was performed on the clinical data of 60 patients with recurrent patellar dislocation admitted to the First Affiliated Hospital of Kunming Medical University from January 2018 to December 2022.The patients included 29 males and 31 females,with age range of 14‑40 years[(28.6±7.6)years].The 3D printed guide plate was used to locate the femoral tunnel in 30 patients for medial patellofemoral ligament reconstruction(3D guide group),and C‑arm X‑ray machine was used for another 30 patients(conventional group).(1)CT data of the knee joint were collected before surgery and at 7 days after surgery.Mimics 19.0 software was introduced to measure the distance between the center of femoral tunnel and Schöttle point after surgery.(2)Knee Lysholm score and Kujala score were used to evaluate the knee function before and at 3,6,9 and 12 months after surgery.(3)At the same time points,Opti‑Knee^(TM) 3D knee kinematics analysis system was used to collect the forward and backward displacement,up and down displacement,internal and external displacement,internal and external flipping angle,internal and external rotation angle,and flexion and extension angle of the affected knee joint.The range of each freedom degree was calculated and 6 freedom degree items of 30 healthy people were subjected to knee kinematics analysis.Results All patients were followed up for 12‑15 months[(12.3±0.7)months].(1)The distance between the center of femoral tunnel and Schöttle point in the 3D guide group was(5.5±2.3)mm,smaller than that in the conventional group[(7.6±2.5)mm](P<0.01).(2)The Lysholm score and Kujala score of the 3D guide group and conventional gruop gradually increased after surgery(all P<0.01).There were no significant differences in the L

关 键 词：髌骨脱位 打印 三维 韧带 关节 人体运动学 实用 

分 类 号：R687.3[医药卫生—骨科学]