自主设计个体化截骨导板在初次全膝关节置换中的应用

Clinical Application of Independently and Individually Designed Cutting Template in Primary Total Knee Arthroplasty

【目的】探讨自主设计的个体化截骨导板应用于初次全膝关节置换的可行性及有效性，为膝关节置换的截骨提供一种新的参考方式。【方法】将2013年9月到2014年12月本院行初次全膝关节置换的膝关节骨性关节炎患者随机分为A、B两组。A组（导板组）：采用自主设计的个体化3D打印截骨导板；B组（对照组）：采用传统的截骨工具进行手术。分别记录并比较两组患者手术时间、围手术期失血量、术后下肢力线、术后3个月膝关节HSS（HospitalforSpecialSurgery）评分。【结果】A组围手术期失血量低于B组，但两者的差异没有统计学意义。与A组比较，B组手术时间更长，且术后下肢力线偏离中立位机械轴相对较多；术后3个月随访，HSS评分A组较B组更高。【结论】尽管术后长期结果尚未可知，个体化截骨导板的使用可以简化操作步骤、缩短手术时间以及获得更满意的下肢力线和评分，是值得推荐的应用于全膝关节置换的一种新的参考方法。

[Objective]To explore the feasibility and efficacy of independently designed individualized cutting template in primary total knee arthroplasty provide a novel reference for the bone-cutting of total knee arthroplasty.[Methods]From September 2013 to December 2014, patients with initial knee osteoarthritis underwent total knee arthroplasty were randomly divided into Group A （the template group）and Group B（the control group）. The individualized 3D printing osteotomy template which was independently designed was adopted by Group A .Group B （the control group） used the conventional cutting tools for surgery. The knee HSS（Hospital for Special Surgery） score（ 3 months after surgery）, the operation time, preoperative blood loss and postoperative lower limb force line of the two groups were recorded and compared .[Results]The preoperative blood loss in the group A was lower than that in the B group, but the difference was not statistically signifi- cant. Compared with group A, the operation time was longer in group B, and the mechanical axis of the lower limb force line was more than that of the neutral position, and the HSS score in group B was higher than in group A in 3-month follow-up. [Conclusion] Although the postoperative long-term results are not yet known, the individual use of osteotomy template can simplify operation steps, shorten the operation time and get more satisfied lower limb force line. It is recommended as a new method in total knee arthroplasty.