3D打印个性化导板辅助的内侧开放楔形胫骨高位截骨术与传统截骨方法比较  

Comparison of 3D-Printed Patient-Specific Instrumentation-Assisted Medial Open-Wedge High Tibial Osteotomy with Conventional Osteotomy Method

作　　者：周峰[1] 朱晓航 许平成 符鹏飞 郭炯炯[1] 张磊[1] ZHOU Feng;ZHU Xiaohang;XU Pingcheng;FU Pengfei;GUO Jiongjiong;ZHANG Lei(Department of Orthopaedics,the First Affiliated Hospital of Soochow University,Suzhou 215026,Jiangsu,China;Department of Orthopaedics,Wujiang Fourth People’s Hospital,Suzhou 215200,Jiangsu,China)

机构地区：[1]苏州大学附属第一医院骨科,江苏苏州215026 [2]苏州市吴江区第四人民医院骨科,江苏苏州215200

出　　处：《医用生物力学》2024年第6期1086-1092,共7页Journal of Medical Biomechanics

基　　金：苏州市姑苏卫生人才计划(GSWS2022004);苏州大学苏州医学院临床医学高峰项目(ML12201323)。

摘　　要：目的分析比较3D打印个性化导板(patient-specific instrumentation,PSI)辅助的内侧开放楔形胫骨高位截骨术(open-wedge high tibial osteotomy,OWHTO)与传统内侧OWHTO在术后力学稳定性、力线调整的精确性以及临床疗效等方面的差异。方法收集2019年1月~2022年1月期间被诊断为膝骨关节炎并接受OWHTO患者资料。根据手术方法分为传统方法组(23人)和3D打印PSI辅助组(18人)。通过对比两组患者术前规划的目标矫正髋-膝-踝角(hip-knee-ankle,HKA)与术后HKA角差值、术前胫骨后倾角(posterior tibial slope,PTS)和术后PTS角差值,评估两种方法矫正的精度。收集分析两组患者术前、术后1、6、12和24个月Lysholm评分、膝关节疼痛评分(visual analogue scale,VAS)和西安大略和麦克马斯特大学骨关节炎指数(WOMAC)评分作为患者的临床疗效指标。收集分析两组患者术后并发症的发生情况,评估PSI辅助OWHTO的安全性。结果两组患者的人口学特征、术前影像学和临床症状没有差异(P>0.05)。在矫正精度结果方面,传统OWHTO的HKA角差值为2.7°±1.8°,3D打印PSI辅助OWHTO的HKA角差值0.8°±1.1°(P<0.001)。传统OWHTO的PTS角差值为2.8°±2.2°,PSI辅助OWHTO的PTS角差值1.7°±1.9°(P=0.003)。在临床疗效方面,PSI辅助组的手术时间为(59.2±14.8)min,显著短于传统方法组的(87.6±21.4)min(P=0.019)。PSI辅助组患者Lysholm、VAS、WOMAC评分在术后各个随访时间点优于传统方法组。在手术并发症方面,传统方法组共有4例(17.3%)患者发生术后并发症,PSI辅助组有3例(16.7%),两组间无明显统计学差异。结论与传统方法相比,3D打印PSI辅助OWHTO可以获得更好的精确度、更好地矫正下肢力线,并且具有良好的临床疗效和安全性。研究结果为临床医生选择手术方案提供有益的参考。Objective To analyze and compare the differences between 3D-printed patient-specific instrumentation(PSI)-assisted medial open-wedge high tibial osteotomy(OWHTO)and conventional medial OWHTO in terms of the postoperative mechanical stability,accuracy of weight-bearing alignment adjustment,and clinical outcomes.Methods Data from patients diagnosed with knee osteoarthritis(KOA)and undergoing OWHTO from Jan.2019 to Jan.2022 were collected.The patients were divided into the conventional method group(23 individuals)and 3D-printed PSI-assisted group(18 individuals)based on the surgical methods.The accuracy of correction between the two methods was evaluated by comparing the preoperatively planned target correction of the hip-knee-ankle(HKA)angle with the postoperative HKA angle difference.The preoperative posterior tibial slope(PTS)and postoperative PTS angle differences were also assessed.The clinical efficacy of the two methods was assessed by collecting and analyzing the Lysholm score,visual analog scale(VAS),and Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)of the patients in both the groups prior to surgery and at the 1st,6th,12th,and 24th month postoperatively.The occurrence of postoperative complications in both the groups was analyzed to evaluate the safety of PSI-assisted OWHTO.Results There were no differences in demographic characteristics,preoperative imaging observations,and clinical symptoms between the two groups(P>0.05).With regard to the results of correction accuracy,the postoperative HKA angle difference was 2.7°±1.8°in the conventional OWHTO group and 0.8°±1.1°in the 3D-printed PSI-assisted OWHTO group(P<0.001).The postoperative PTS angle difference was 2.8°±2.2°for conventional OWHTO and 1.7°±1.9°for PSI-assisted OWHTO(P=0.003).In terms of clinical efficacy,the surgical time of the PSIassisted group was 59.2±14.8 min.This was significantly shorter than that of the conventional method group(87.6±21.4 min)(P=0.019).The Lysholm,VAS,and WOMAC scores of the PSI-assis

关 键 词：膝骨关节炎 胫骨高位截骨术 3D打印 个性化导板 矫正精度 临床疗效 

分 类 号：R318.01[医药卫生—生物医学工程]