个性化与常规截骨导板全膝关节置换比较

Total knee arthroplasty with 3D- printed patient- specific instruments versus conventional counterpart

摘要:

[目的] 比较3D 打印个性化定制导板（patient-specific instruments, PSI） 与常规截骨导板全膝关节置换术（totalknee arthroplasty, TKA） 的临床疗效。[方法] 回顾性分析2019 年1 月—2021 年12 月行TKA 治疗的100 例患者临床资料。按照术前医患沟通结果，47 例采用3D 打印个性化定制截骨导板，53 例采用常规截骨导板。比较两组围术期、随访及影像结果。[结果] 个性组的手术时间[(80.0±12.7) min vs (66.1±12.3) min, P＜0.05]、治疗费用[(5.0±1.0) 万元vs (4.2±0.5) 万元, P＜0.05] 均显著多于常规组；但是，前者的切口长度[(9.2±1.5) cm vs (14.0±2.6) cm, P＜0.05]、术中失血量[(42.0±10.8) ml vs (50.1±12.8) ml, P＜0.05]、术后引流量[(124.5±23.6) ml vs (154.3±20.7) ml, P＜0.05]、下地行走时间[(24.0±4.5) h vs (28.3±5.6) h, P＜0.05]、住院时间[(6.8±2.6) d vs (9.0±3.0) d, P＜0.05] 均显著优于后者。随访时间平均（18.0±3.5） 个月，个性组恢复完全负重活动时间[(20.6±2.8)d vs (25.0±3.0) d, P＜0.05] 显著早于常规组。随时间推移，两组患者HSS 评分、膝伸-屈ROM、VAS 评分及WOMAC 评分均显著改善（P＜0.05），相应时间点，两组间上述指标的差异均无统计学意义（P＞0.05）。影像方面，个性组FTA 角偏差值[(1.0±0.3)°vs (2.2±0.7)°, P＜0.05]、FFC 角偏差值[(0.4±0.1)° vs (1.3±0.5)°, P＜0.05]、FTC 角偏差值[(0.2±0.0)° vs (1.2±0.3)°, P＜0.05]、LFC 角偏差值[(4.0±0.9)° vs (8.8±1.3)°, P＜0.05]、LTC 角偏差值[(0.5±0.1)° vs (0.9±0.3)°, P＜0.05] 均显著小于常规组。[结论] 3D 打印个性化定制导板用于TKA 可取得与传统TKA 类似的效果。前者虽手术时间相对长，但在恢复下肢冠状位力线，减少术中失血量方面较后者有明显优势。

Abstract:

[Objective] To compare the clinical efficacy of 3D printed patient-specific instruments (PSI) versus conventional instru-ments (CI) in total knee arthroplasty (TKA). [Methods] A retrospective study was conducted on 100 patients who received primary unilater-al TKA from January 2019 to December 2021. According to preoperative doctor-patient communication, 47 patients had TKA performedwith PIS, while the other 53 patients were treated with CI. The perioperative, follow-up and imaging data of the two groups were compared.[Results] Although the PSI group consumed significantly longer operation time [(80.0±12.7) min vs (66.1±12.3) min, P＜0.05], and signifi-cantly higher hospital expense [(5.0±1.0) ten thousand yuan vs (4.2±0.5) ten thousand yuan, P＜0.05] than the CI group, the former provedsignificantly superior to the latter in terms of incision length [(9.2±1.5) cm vs (14.0±2.6) cm, P＜0.05], intraoperative blood loss [(42.0±10.8)ml vs (50.1±12.8) ml, P＜0.05], postoperative drainage [(124.5±23.6) ml vs (154.3±20.7) ml, P＜0.05], postoperative walking time [(24.0±4.5)hours vs (28.3±5.6) hours, P＜0.05] and hospital stay [(6.8±2.6) days vs (9.0±3.0) days, P＜0.05]. The follow-up period lasted for (18.0±3.5)months on a mean, and the PSI group resumed full weight-bearing activities significantly earlier than the CI group [(20.6±2.8) days vs(25.0±3.0) days, P＜0.05]. The HSS score and knee extension-flexion ROM significantly increased, whereas the VAS and WOMAC scoressignificantly decreased in both groups over time (P＜0.05), which proved not statistically significant between the two groups at any timepoints accordingly (P＞0.05). Radiographically, the PSI group also proved significantly superior to the CI group in terms of FTA deviation[(1.0±0.3)° vs (2.2±0.7)°, P＜0.05], FFC deviation [(0.4±0.1)° vs (1.3±0.5)°, P＜0.05], FTC deviation [(0.2±0.0)° vs (1.2±0.3)°, P＜0.05], LFCdeviation [(4.0±0.9)° vs (8.8±1.3)°, P＜0.05] and LTC deviation [(0.5±0.1)° vs (0.9±0.3)°, P＜0.05]. [Conclusion] The TKA with 3D-printedpatient-specific instruments achieve similar consequence to conventional instruments. Although this personalized technique consumes rela-tively longer operation time, it has obvious advantages over the conventional technique in restoring the coronal alignment of lower extremity and reducing intraoperative blood loss.