内侧骨性关节炎3D打印与常规胫骨高位截骨比较

3D printed guide assisted high tibial osteotomy versus freehand counterpart for medial knee osteoarthritis

摘要:

[目的] 比较 3D 打印个体化 （patient-specific instrument, PSI） 导板与常规内侧开放胫骨高位楔形截骨术 （medial open-wedge high tibial osteotomy, MOWHTO）治疗膝内侧骨关节炎的临床疗效。[方法]回顾性分析本科 2017 年 10 月—2021 年 3 月行 MOWHTO 治疗的 69 例患者的临床资料，根据医患沟通结果，37 例采用 PSI 导板 （3D 组），32 例采用传统手术方法 （常规组）。比较两组患者围手术期、随访结果及影像结果。[结果]3D 组术中出血量 [(48.7±39.9) ml vs (68.9±50.5) ml, P＜0.05]、 透视次数 [(10.5±1.4) 次 vs (15.4±2.0) 次, P＜0.05] 显著优于常规组。两组手术时间、切口愈合等级的差异均无统计学意义 （P＞ 0.05）。随访时间平均（23.6±1.6）个月，两组间完全负重活动时间的差异无统计学意义（P＞0.05），术后随时间推移，两组膝伸屈 ROM、HSS 评分、VAS 评分、WOMAC 评分均显著改善（P＜0.05），末次随访时两组间上述指标的差异均无统计学意义（P＞ 0.05）。影像方面，与术前相比，术后 6 个月及末次随访，两组膝关节 K-L 分级无显著变化 （P＞0.05）。相应时间点，两组间 FTA、MPTA、PTS 的差异均无统计学意义（P＞0.05）。[结论] 3D 打印 PSI 导板术中的应用较常规能够减少术中 C 形臂 X 线机的使用次数，减少术中出血量，但对手术时间无明显影响。

Abstract:

[Objective] To compare the clinical consequences of medial open-wedge high tibial osteotomy (MOWHTO) by assistance with 3D printed patient-specific instrument (PSI) guides versus the conventional freehand technique for medial knee osteoarthritis. [Meth- ods] A retrospective study was conducted on 69 patients who received MOWHTO in our department from October 2017 to March 2021. Ac- cording to doctor-patient communication, 37 patients were treated with PSI guides (3D group), while other 32 patients were treated with tradi- tional freehand methods (routine group). The data regarding perioperative period, follow- up and imaging were compared between the two groups. [Results] The 3D group proved significantly superior to the routine group in terms of intraoperative bleeding [(48.7±39.9) ml vs (68.9±50.5) ml, P＜0.05], fluoroscopy times [(10.5±1.4) times vs (15.4±2.0) times, P＜0.05], despite of insignificant differences in operation time and incision healing grade between the two groups (P＞0.05). The mean follow-up time was of (23.6±1.6) months, and there was no sig- nificant difference in time to resume full weight-bearing activity between the two groups (P＞0.05). The knee extension-flexion ROM, HSS score, VAS score and WOMAC score significantly improved in both groups over time (P＜0.05), whereas which were not significantly differ- ent between the two groups at the last follow-up (P＞0.05). In terms of imaging, the K-L classification for osteoarthritis remained unchanged with time in both groups (P＞0.05). At any corresponding time point, there were no significant differences in FTA, MPTA and PTS between the two groups (P＞0.05). [Conclusion] The application of 3D printed PSI guides does reduce the intraoperative fluoroscopy times and blood loss, but has no significant impact on the operative time of the MOWHTO for medial knee osteoarthritis.