股内侧肌下方入路并3D打印导板辅助全膝关节置换术的临床应用

The Clinical Application of Total Knee Arthroplasty with Subvastus Approach based on 3D Printing Technique

目的评估股内侧肌下方入路并3D打印导板辅助全膝关节置换术的治疗效果。方法回顾分析2015年3月至2016年3月沈阳市骨科医院关节外科应用股内侧肌下方入路并3D导板辅助全膝关节置换术治疗的骨关节炎患者63例,分别于术前、术后3个月进行视觉模拟评分(VAS评分)、膝关节功能评分(HSS评分)及髌骨Feller评分的评估。并于术前、术后3个月及6个月对患者股四头肌肌力及膝关节活动度进行评定。于术前、术后1个月进行伸直位Q角及其髌骨外推Q角,屈曲30°位Q角及其髌骨外推Q角的测量。结果所有手术均顺利完成,63例患者均获完整随访,随访时间12~18个月,平均随访(14.5±2.7)个月。患者术后VAS评分[(1.8±0.4)分]、HSS评分[(93±6)分]和髌骨Feller评分[(26±4)分]较术前[(6.8±2.2、37±6、16±6)分]有明显改善(t=18.223,t=-51.741,t=-11.485,P<0.05);术后6个月患者股四头肌肌力[(80±8)分]较术前[(74±8)分]有改善,差异有统计学意义(F=20.771,P<0.05)。患者术后3个月膝关节屈伸活动范围[屈:(118±5)°,伸:(1.0±0.9)°]较术前[屈:(80±14)°,伸:(3.8±1.8)°]有改善,差异具有统计学意义(F=306.062,F=105.050,P<0.05)。伸直位和屈曲30°位Q角及其髌骨外推Q角,以及两种状态下Q角差值,术后较术前均有明显改善,差异均有统计学意义(伸直位:t=20.489,t=6.753,t=4.891,屈曲位:t=21.497,t=2.853,t=5.698,P<0.05)。结论应用股内侧肌下方入路并3D打印导板辅助下完成人工全膝关节置换术,创伤小、效果好、并发症少。

Objective To evaluate the clinical effect of 3D printing guided total knee arthroplasty（TKA） using subvastus approach. Methods We retrospectively reviewed 63 osteoarthritis patients who underwent 3D printing guided by subvastus approach in our department between March 2015 and March 2016.Visual analogue scale, knee function score and patella Feller score were assessed before and 3 months after surgery. Patients＇ quadriceps muscle strength and knee joint activity were assessed preoperatively, 3 months and 6 months postoperatively. The Q angle of extension and its patella extrapolated Q angle, 30° Q angle of flexion and its patella extrapolation Q angle were measured preoperatively and 1 month postoperatively.Results All patients were successfully followed up for 12-18 months with an average of 14.5 ±2.7 months.The postopeartive VAS score（1.8±0.4）, HSS score（93±6） and patella Feller score（26±4） were significantly different than the preoperative data（6.8±2.2、37±6、16±6）（t=18.223, t=-51.741, t=-11.485, P〈0. 05）. Muscle strength（80±8） was significantly improved compared with preoperative（74±8） data, difference was statistically significant（F=20.771, P〈0. 05）. The range of knee flexion and extension activities at 3 months postoperatively was statistically improved（F=306.062, F=105.050, P〈0. 05）. The extension angle and 30° Q angle of flexion and its patella extraverted Q angle were significantly improved compared with those preoperatively,differences were statistically significant（extension position： t=20.489, t=6.753, t=4.891, flexion： t=21.497, t=2.853, t=5.698, P〈0. 05）. Conclusion The application of the 3D printing guided total knee arthroplasty with subvastus approach is effective, with fewer complications and less trauma.