3D打印精确化截骨导板在胫骨平台后倾角异常增大的前交叉韧带翻修中的应用  

Application of 3D printing accurate osteotomy guide combined with the revision of anterior cruciate ligament with abnormally increased posterior slope of tibial plateau

作　　者：魏志亨 关天民[1] 刘青 弓爵 向先祥 Wei Zhiheng;Guan Tianmin;Liu Qing;Gong Jue;Xiang Xianxiang(School of Mechanical Engineering,Dalian Jiaotong University,Dalian 116028,Liaoning Province,China;Xinhua Hospital Affiliated to Dalian University,Dalian 116021,Liaoning Province,China)

机构地区：[1]大连交通大学机械工程学院,辽宁省大连市116028 [2]大连大学附属新华医院,辽宁省大连市116021

出　　处：《中国组织工程研究》2025年第33期7130-7136,共7页Chinese Journal of Tissue Engineering Research

摘　　要：背景:胫骨平台后倾角异常增大的前交叉韧带重建术后再断裂患者,行前交叉韧带重建同时联合胫骨前方闭合截骨,但缺少精确化的截骨工具。目的:探究3D打印精确化截骨导板在胫骨平台后倾角过大的前交叉韧带翻修中的临床疗效。方法:回顾性收集30例行前交叉韧带翻修联合胫骨前方闭合截骨患者的病历资料,按手术方法分为2组,试验组15例行3D打印截骨导板辅助手术,对照组15例行常规手术。对比两组患者以下指标:截骨时间、透视次数、术中及术后24 h出血量,术前及术后3个月胫股解剖角、胫骨近端内侧解剖角、胫骨平台后倾角以及计划胫骨平台后倾角矫正角度与实际矫正角度的差值,术前及术后3,24个月KT-2000侧侧差值,术前、术后即刻及术后24个月lachman试验和pivot-shift试验结果,术前及术后3,24个月国际膝关节评分委员会评分及Lysholm评分。结果与结论:①试验组截骨时间、透视次数、术中及术后24 h出血量均少于对照组,差异有显著性意义(P<0.05);②两组患者术后胫骨平台后倾角较术前明显减小,术后胫股解剖角、胫骨近端内侧解剖角与术前无明显变化;试验组术前胫骨平台后倾角计划度数与术后实际度数的差值(0.64±0.41)°较对照组(2.18±0.54)°小,差异有显著性意义(P<0.001);③两组患者术后KT-2000侧侧差值与术前相比显著减少(P<0.05);术后3,24个月,试验组术后KT-2000侧侧差值与对照组相比无显著差异(P>0.05);两组患者术后即刻、术后3,24个月lachman试验和pivot-shift试验均为阴性;④两组患者术后国际膝关节评分委员会评分和Lysholm评分与术前相比显著增加(P<0.05);术后3个月,试验组国际膝关节评分委员会评分和Lysholm评分显著高于对照组(P<0.05);术后24个月,试验组国际膝关节评分委员会评分和Lysholm评分与对照组相比无显著差异(P>0.05);⑤结果表明3D打印精确化截骨导板辅助使BACKGROUND:For patients with anterior cruciate ligament re-rupture after reconstruction with abnormally increased posterior slope of the tibial plateau,anterior cruciate ligament reconstruction combined with anterior closing-wedge high tibial osteotomy was performed.However,there is a lack of precise tools for osteotomy.OBJECTIVE:To investigate the effectiveness of three-dimensional(3D)printed accurate osteotomy template in anterior cruciate ligament revision for patients with excessive posterior slope.METHODS:The medical records of 30 patients who underwent anterior cruciate ligament revision combined with anterior closing-wedge high tibial osteotomy were retrospectively collected and divided into two groups according to the operation method.The trial group(n=15)was assisted by 3D printing osteotomy guide plate.The control group(n=15)was conventional surgery.The osteotomy time,fluoroscopy times,intraoperative and 24 hours postoperative blood loss,preoperative and 3 months postoperative tibiofemoral anatomical angle,medial proximal tibial anatomical angle,posterior slope,the difference between planned posterior slope correction angle and actual correction angle,and KT-2000 side-to-side difference before operation,3 and 24 months after operation were compared between the two groups.Lachman test and Pivot shift test were performed before operation,immediately after operation,and 24 months after operation.International Knee Documentation Committee score and Lysholm score were performed before operation,3 and 24 months after operation.RESULTS AND CONCLUSION:(1)The osteotomy time,fluoroscopy times,and blood loss during operation and 24 hours after operation in the trial group were significantly less than those in the control group(P<0.05).(2)The posterior slope of the two groups decreased significantly after operation.There was no significant change in tibiofemoral anatomical angle and medial proximal tibial anatomical angle after operation.The difference between preoperative planned and postoperative actual posterior

关 键 词：3D打印 精确化截骨导板 胫骨前方闭合截骨术 前交叉韧带翻修 越顶位 数字化骨科 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R873.5