膝骨性关节炎3D打印导板与传统胫骨高位截骨比较△

3D-printed patient-specific instrumented high tibial osteotomy versus traditional counterpart for medial knee osteoarthri⁃ tis

摘要:

［目的］ 评价 3D 打印个性化导板 （patient-specific instrumentation, PSI） 辅助胫骨高位截骨 （high tibial osteotomy, HTO）治疗内翻型膝骨关节炎（knee osteoarthritis, KOA）的精准度和疗效。［方法］回顾性分析 2019 年 1 月—2021 年 2 月在本院骨科行内侧开放楔形 HTO 治疗的 35 例 KOA 患者的临床资料。根据医患沟通结果，17 例采用 3D 打印 PSI 辅助截骨，18 例采用传统方法截骨。比较两组围术期情况、随访和影像资料。［结果］ 两组患者均顺利完成手术，3D 组手术切口总长度、手术时间、术中失血量、术中透视次数、下地行走时间和术后住院时间均显著优于传统组 （P<0.05）。两组早期并发症发生率的差异无统计学意义 （P>0.05）。随访时间平均 （14.34±2.03） 个月，两组恢复完全负重活动时间差异无统计学意义 （P>0.05）。随着时间推移，两组患者的 VAS 评分、HSS 评分和膝关节伸屈 ROM 均显著改善 （P<0.05）。影像方面，与术前相比，术后两组患者的 WBLR 和 MPTA 均显著增加（P<0.05），而 PTS 无明显改变（P>0.05），膝骨关节炎 K-L 分级显著改善（P<0.05）。术后 6、12 个月随访时，3D 组的 WBLR 和 MPTA 均显著大于传统组 （P<0.05），两组间 K-L 评级的差异无统计学意义 （P>0.05）。 至末次随访时，所有患者截骨均已愈合，两组愈合时间的差异无统计学意义 （P>0.05）。［结论］ 相比传统方法截骨，3D 打印 PSI 辅助的内侧开放楔形 HTO，术中透视次数更少，手术时间更短，下肢力线矫正更精确。

Abstract:

[Objective] To investigate the accuracy and efficacy of 3D printed patient-specific instrumented (PSI) high tibial osteotomy (HTO) for medial knee osteoarthritis (KOA) , by comparing with traditional HTO . [Methods] A retrospective study was conducted on 35 pa- tients who underwent medial open wedge HTO for medial KOA in our department from January 2019 to February 2021. Based on preopera- tive doctor-patient communication, 17 patients received 3D printed PSI HTO (the 3D group), while the remaining 18 patients underwent the traditional HTO (the traditional group) . The documents regarding to perioperative period, follow-up and radiographs were compared be- tween the two groups. [Results] All patients in both groups had the surgical procedures performed smoothly. The 3D group proved signifi- cantly superior to the traditional group in terms of total length of surgical incision, operative time, blood loss, fluoroscopy times, walking time and postoperative hospital stay (P＜0.05) , whereas without significant differences between them in the occurrence of early complica- tions (P＞0.05) . All the patients were followed up from 12 to 18 months with a mean of (14.34±2.03) months. The 3D group resumed full weight-bearing activity slightly earlier than the traditional group, despite of no statistically significant difference between them (P＞0.05) . The VAS and HSS scores and knee extension range of motion (ROM) in both groups significantly improved over time (P＜0.05) , which were not statistically significant between them at any matching time point (P＞0.05) . Radiographically, the weight bearing line ratio (WBLR) , me- dial proximal tibial angle (MPTA) and Kellgren- Lawrence (K- L) classification significantly improved, whereas the posterior tibial slope (PTS) remained unchanged in both groups postoperatively compared with those preoperatively (P＜0.05) . At 6 and 12 months after surgery, the 3D group was significantly superior to the traditional group in terms of WBLR and MPTA (P＜0.05) , whereas no a statistical difference in K-L grade between them (P＞0.05) . By the time of latest follow-up, bony healing achieved in all the patients, which was not significantly different between the two groups (P＞0.05) . [Conclusion] Compared with conventional osteotomy, 3D printed PSI OWHTO has advantages of fewer intraoperative fluoroscopy, shorter operative time and more accurate alignment of lower extremity correction.