3D打印辅助胫骨高位截骨治疗内翻型膝骨关节炎△

3D printing-assisted high tibial osteotomy for varus knee osteoarthritis

摘要:

[目的] 评价3D 打印辅助胫骨高位截骨术（high tibial osteotomy, HTO） 治疗内翻型膝骨关节炎（knee osteoarthritis,KOA） 的临床疗效。[方法] 回顾分析2018 年1 月—2019 年6 月本院采用HTO 治疗内翻型KOA 94 例患者的临床资料。依据医患沟通结果， 47 例采用3D 辅助HTO，另外47 例采用传统徒手HTO。比较两组围术期、随访和影像资料。[结果] 3D 组在手术时间[(58.8±5.0) min vs (65.8±5.4) min, P＜0.001] 和术中透视次数[(2.1±0.9) 次vs (7.5±1.6) 次, P＜0.001] 均显著优于徒手组。两组患者均随访24 个月以上。随时间推移，两组患者伸屈ROM、VAS、WOMAC 和HSS 评分均显著改善（P＜0.05）。术后6 个月3D组在伸屈ROM [(96.8±5.8)° vs (88.7±5.2)°, P＜0.001]、VAS [(5.7±1.1) vs (6.6±1.4), P＜0.001]、WOMAC [(28.7±3.9) vs (34.8±4.0), P＜0.001] 和HSS 评分[(58.5±7.0) vs (53.3±6.9), P＜0.001] 均显著优于徒手组。影像方面，与术相比，末次随访时两组FTA、MPTA 以及内侧室K-L 评级均显著改善（P＜0.05），然而，两组PTS 和外侧室K-L 评级均无显著变化（P＞0.05）。相应时间点，两组间FTA、MPTA、PTS，以及内侧室和外侧室K-L 评级的差异均无统计学意义（P＞0.05）。[结论] 3D 打印辅助HTO 治疗内翻型KOA，可增加截骨精确性，提高手术效率，改善临床结果。

Abstract:

[Objective] To evaluate the clinical efficiency of 3D printing-assisted high tibial osteotomy (HTO) in the treatment of varusknee osteoarthritis (KOA). [Methods] A retrospective study was performed on 94 patients who received HTO for varus KOA treated from Jan-uary 2018 to June 2019. According to doctor-patient communication, 47 patients received 3D printing-assisted HTO, while the other 47 pa-tients received traditional freehand HTO. The perioperative, follow-up and imaging data of the two groups were compared. [Results] The 3Dgroup proved significantly superior to the freehand group in terms of operative time [(58.8±5.0) min vs (65.8±5.4) min, P＜0.001] and intraop-erative fluoroscopic frequency [(2.1±0.9) times vs (7.5±1.6) times, P＜0.001]. All the patients in both groups were followed up for more than24 months. The flexion-extension range of motion (ROM), VAS, WOMAC, and HSS scores significantly improved over time in both groups(P＜0.05). The 3D group was significantly better than the freehand group regarding to flexion-extension ROM [(96.8±5.8)° vs (88.7±5.2)°, P＜0.001], VAS sore [(5.7±1.1) vs (6.6±1.4), P＜0.001], WOMAC score [(28.7±3.9) vs (34.8±4.0), P＜0.001] and HSS score [(58.5±7.0) vs (53.3±6.9), P＜0.001] 6 months postoperatively. Radiographically, the femorotibial angle (FTA), medial proximal tibial angle (MPTA), and Kellgren-Lawrence (K-L) scale for osteoarthritis of the medial compartment significantly improved in both groups at the latest follow-up comparedwith those before surgery (P＜0.05), however, the posterior tibial slope (PTS) and K-L scale of the lateral compartment remained unchangedin both of them between the two time points (P＞0.05). In addition, there were no significant differences in FTA, MPTA, PTS, and K-L scalesbetween the two groups at any time points accordingly (P＞0.05). [Conclusion] The 3D print-assisted HTO does bolster accuracy of the oste-otomy, enhance surgical efficiency and improve the clinical outcomes for treatment of varus KOA.