基于3D打印的个性化截骨技术与传统方式行全膝关节表面置换的临床对比

Total knee arthroplasty with 3D printing technique versus conventional surgery:comparison of the outcomes

目的研究基于3D打印个性化截骨技术在全膝关节置换中的临床应用价值。方法选择2015年10月~2017年2月间17例20膝关节疼痛及功能障碍患者采用3D打印截骨导板辅助下行全膝关节置换手术,同期选择16例18膝采用传统手术方式行全膝关节置换术。术前两组患者年龄、性别、KSS评分,均无统计学差异性(P>0.05)。记录手术时间,术中出血量、手术实际股骨远端、胫骨近端截骨量,术后X线片测量平均股骨、胫骨机械轴夹角(MFTA),矢状位胫骨平台后倾角(STCA)数值并进行统计学分析,末次随访时行KSS评分。结果术后随访7~23月,两组病例均未出现关节感染,假体松动、移位、下沉等并发症。3D导板组术前规划的股骨远端、胫骨近端截骨量与手术实际数值无统计学差异性(P>0.05);3D导板组的手术时间、术中出血量、MFTA值、STCA值与传统组相比差异有统计学意义(P<0.05);随访末期3D导板组KSS临床及功能评分均高于传统组,两组间差异有统计学意义(P<0.05)。结论基于3D打印个性化截骨技术简化了全膝关节表面置换术手术的操作步骤,可提高手术的精准度与临床疗效,值得进一步推广应用。

Objective To compare the clinical outcomes of patients receiving total knee arthroplasty(TKA) using 3D printing technique and conventional surgical methods. Methods From October, 2015 to February, 2017, 17 patients(20 knees)underwent TKA with the assistance of individualized navigation template and 16 concurrent patients(18 knees) matched for age, gender and knee society score received conventional TKA. The operation time, blood loss, and osteotomy data of the femoral condyle and tibia plateau were recorded. The mean femorotibial angle(MFTA) and sagittal tibial component angle(STCA) after the operation and the KSS at the last follow-up were compared between the two groups. Results All the patients were followed up for 7-23 months, during which no infection or prosthesis loosening or motion was found. In patients receiving surgery with 3D printing technique, the osteotomy data of the femoral condyle and tibia plateau in the actual surgeries were consistent with those in surgical plans(P>0.05). The patients in the 3D group had a significantly shorter operation time and a higher KSS score than those in the conventional group(P<0.05). Significant differences were found between the two groups in postoperative MFTA and STCA(P<0.05). Conclusion The application of 3D printing technique can simplify the surgical procedure and improve the surgical precision and efficacy of TKA.