3D打印截骨导板在膝关节单髁置换中的应用

Clinical application of 3D printing plate in unicompartmental knee arthroplasty

目的探索利用3D打印定位截骨导板行膝关节单髁置换(unicompartmental knee arthroplasty,UKA)治疗膝关节内侧间室骨性关节炎的近期临床疗效。方法选取2016年6—10月阜阳市人民医院骨科收治25例膝关节内侧间室骨性关节炎患者,行UKA治疗,根据手术方式不同分为3D打印组(12例)和常规组(13例),比较手术时间、出血量(术中出血量+术后引流量)、术后胫骨假体力线偏差(冠状位胫骨假体的垂线与胫骨机械轴的夹角)和术后1、3、6个月时美国特种外科医院(hospital for special surgery,HSS)膝评分,观察3D打印截骨导板在膝关节单髁置换中的临床疗效。结果所有患者均获得随访,随访时间6~10个月。3D打印组在出血量、胫骨假体立线偏差方面优于常规组[出血量:(237.1±143.7)ml vs.(391.2±163.8)ml、胫骨假体立线偏差:(1.5±0.9)°vs.(2.9±1.6)°],2组比较差异均有统计学意义(均P<0.05);2组手术时间比较差异无统计学意义(P>0.05)。2组组内相比,术前与术后1、3、6个月HSS评分两两比较差异均有统计学意义(均P<0.05),HSS评分随着时间的延长向好的方向发展,然而2组组间术后同期HSS评分比较差异无统计学意义(P>0.05)。结论利用3D打印定位截骨导板行膝关节单髁置换出血少,创伤小,截骨精准,能够个体化治疗,近期疗效好。

Objective To explore the short-term outcome of unicompartmental knee arthroplasty （UKA） with 3D print position!ng osteotomy guide plate in treatment of end-stage medial compartment osteoarthritis （MCOA）. Methods From June, 2016 to October, 2016, 25 patients with MCOA were treated in our department. The patients were divided into 3D group and conventional group according to the different surgical methods. The operation time, volume of bleeding （ Intrao- perative volume of bleeding with postoperative drainage）, postoperative tibial prosthesis deviation （the coronal angle be- tween perpendicular line of tibial prosthesis and tibial mechanical axis） and postoperative 1,3, 6 months HSS score were recorded and compared separately to evaluate the efficacy of UKA with 3 D printing guild plate. Results All patients were followed up to 6 - 10 months （average of 8 months）. The amount of bleeding, tibial prosthesis deviation in 3D group [ （237.1 ± 143.7 ） ml, 1.5± 0.9 ] was superior to the conventional group [ （391.2± 163.8 ） ml, 2.9 ± 1.6 ], the operation time between the two groups [ 3 D group： （ 89.2 ±19.0 ） min, conventional group： （ 94.2± 30.3 ） min] was no significant difference. The differences in HSS score before the operation, 1, 3 and 6 months after the operation in the same group compared to each other were statistically significant. The HSS score had developed in a good way over time. However, the differences of postoperative HSS score between the two groups at the same period were not significant （ P 〉 0.05）. Conclusion UKA with 3D print positioning osteotomy guide plate in treatment of MCOA has a good short-term outcome with less bleeding, accurate osteotomy and individualized treatment.