3D打印截骨槽导板与定位钉导板在全膝关节置换术中的对比研究

A comparative study of 3D printed navigator for total knee arthroplasty based on groove guide plate technique and screw positioning guide technique

目的探讨比较3D打印截骨槽导板与定位钉导板在人工全膝关节置换术(total knee arthroplasty,TKA)中的临床效果。方法选取2015年1月至2016年1月,42例于南京医科大学附属南京医院骨科行单侧TKA的患者采用电脑随机抽样法分为两组,每组21例,A组为截骨槽组,B组为定位钉组,分别对两组患者行下肢全长CT扫描,局部膝关节MRI扫描,所得数据均存为Dicom格式。将Dicom数据导入到Mimics 17.0软件中,利用CT、MRI数据建立具有局部软骨厚度的膝关节三维模型。将模型导入到3-matic软件中,根据模型特征进行模拟截骨,截骨后A组设计为截骨槽导板,B组设计为定位钉导板,最后进行导板的3D打印并记录两组导板打印时间。记录并比较两组术中断裂率、手术时间、术后引流量、术后髋-膝-踝角(hip knee ankle,HKA)、冠状面股骨组件角(frontal femoral component,FFC)、冠状面胫骨组件角(frontal tibial component,FTC)、矢状面胫骨组件角(lateral tibial component,LTC)偏移值及术后1、3、6、12个月的膝关节协会膝关节评分(knee society score,KSS)。结果截骨槽组和定位钉组导板打印时间分别为(152±25)min和(156±23)min(P>0.05)、断裂率分别为14.3%和0%(P<0.05)、手术时间分别为(38.1±7.3)min和(31.2±6.5)min(P<0.05)、术后出血量分别为(197.3±46.4)ml和(220.5±38.5)ml(P>0.05),两组术后的假体特征角度:HKA偏差[(1.7±1.3)°vs.(1.6±1.5)°](P>0.05)、FFC偏差[(1.2±0.8)°vs.(1.3±1.2)°](P>0.05)、FTC偏差[(1.2±1.4)°vs.(1.4±1.5)°](P>0.05)、LTC偏差[(3.2±1.3)°vs.(3.5±1.6)°](P>0.05)。术后1、3、6、12个月的KSS评分差异无统计学意义(P>0.05)。结论 3D打印截骨槽导板与定位钉导板在TKA中均可获得较好的临床效果,但定位钉导板稳定性更好。

Objective To compare the clinical results between 2 kinds of 3D-printed osteotomy navigators for total knee arthroplasty （ TKA ） by the groove guide plate technique and screw positioning guide technique. Methods A total of 42 patients with knee osteoarthritis who underwent unilateral TKA from January 2015 to January 2016 were enrolled in this study. All the patients were randomly divided into 2 groups, with 21 patients in each group. Groove guide plate technique was used in Group A, and screw positioning guide technique in Group B. The 2 groups＇ anatomical data in ＂Dicom＂ form were obtained from full-length CT scanning of lower limbs and partial knee MRI scanning. The data were all reconstructed by Mimics 17.0 software. The 3D model of the knee joint with local cartilage thickness was established by using the CT and MRI data. The model was imported into the 3-matic software, and then osteotomy was simulated based on the model＇s characteristics. Groove guide plate was designed in Group A, and screw positioning guide in Group B. At last, 3D printing was performed, and the printing time of the 2 kinds of navigators were recorded. The navigators＇ intra-operative breakage rate, operation time, postoperative drainage volume,postoperative hip-knee-ankle angle （ HKA ）, frontal femoral component angle （ FFC ）, frontal tibial component angle （ FTC ） and lateral tibial component angle （ LTC ） were recorded and measured between the 2 groups, as well as the knee society score （ KSS ） at 1, 3, 6 and 12 months after operation. Results The 3D printing time was （ 152 ± 25 ） min and （ 156 ± 23 ） min respectively between the 2 groups （ P 〉 0.05 ）. The rate of intra-operative navigator breakage was 14.3% and 0% （ P 〈 0.05 ）. The operation time was （ 38.1± 7.3 ） min and （ 31.2 ± 6.5 ） min （ P 〈 0.05 ）. The postoperative blood loss was （ 197.3 ± 46.4 ） ml and （ 220.5 ± 38.5 ） ml （ P 〉 0.05 ）. The average difference-values of HKA[（ 1.7± 1.3 ）° vs. （ 1.6± 1.5 ）°, （P〉 0.05 ） ], FFC [（1.2±0.8）° vs. （ 1.3± 1.2 ）°, （P〉 0.05 ）], FTC [（ 1.2±1.4 ）° vs. （ 1.4 ± 1.5 ） °, （ p 〉 0.05 ） ] and LTC [ （ 3.2 ± 1.3 ） °vs. （ 3.5± 1.6 ） °, （ p 〉 0.05 ） ] were observed between the 2 groups. There were no significant differences in the KSS at 1, 3, 6 and 12 months after operation （ P 〉 0.05 ）. Conclusions The 3D-printed osteotomy navigator based on groove guide plate technique and screw positioning guide technique may both indicate reasonable postoperative results for TKA. The navigators using screw positioning guide technique may lead to a steady guide during the operative procedure.