3D打印个性化截骨导板与传统截骨方法在内翻性踝关节炎踝上截骨术中的应用比较

Instrumentation with 3D printed patient-specific guides versus conventional techniques in supramalleolar osteotomy for varus ankle osteoarthritis

目的比较3D打印个性化截骨导板与传统截骨方法在内翻性踝关节炎踝上截骨术中的应用效果。方法回顾性分析2017年1月至2018年12月上海交通大学附属第六人民医院骨科治疗的21例踝关节炎患者资料。根据治疗方式不同分为2组:9例患者采用3D打印个性化截骨导板治疗(3D导板组),男6例,女3例;年龄(54.6±8.6)岁;左踝4例,右踝5例;Takakura分期:1期1例,2期3例,3a期5例。12例患者采用传统截骨方法治疗(传统截骨组),男7例,女5例;年龄(53.0±6.5)岁;左踝7例,右踝5例;Takakura分期:1期1例,2期5例,3a期6例。记录并比较3D导板组与传统截骨组患者手术时间、术中出血量、术中透视次数、胫骨前侧关节面角(TAS)、距骨倾斜角(TT)及胫骨侧位关节面角(TLS)影像指标;并评估3D导板组术前、术后上述影像指标的差异。结果3D导板组与传统截骨组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。所有患者术后获3~15个月(平均7.8个月)随访。与传统截骨方法组相比,3D导板辅助组的手术时间(106.2±10.6)min、术中出血量(207.2±16.0)mL、术中透视次数(2±0)次均较少,差异均有统计学意义(P<0.01)。3D导板辅助组术后TAS(94.3°±3.2°)和TT(3.8°±0.8°)角与术前(84.6°±3.5°、7.6°±1.6°)比较,差异均有统计学意义(P<0.01);3D导板辅助组患者术后TAS(94.3°±3.2°)、TT(3.8°±0.8°)和TLS(83.7°±3.4°)与传统截骨方法组患者术后TAS(92.4°±5.9°)、TT(4.2°±1.1°)和TLS(84.2°±2.2°)比较,差异均无统计学意义(P>0.05)。结论与传统截骨方法比,3D打印个性化手术导板在内翻性踝关节炎踝上截骨矫形术中可明显缩短手术时间、减少术中出血量和术中透视次数;个性化截骨导板可辅助术中准确矫正内翻畸形,与传统截骨方法相比,矫正效果基本一致。

Objective To compare instrumentation with 3D-printed patient-specific guides versus conventional techniques in supramalleolar osteotomy for varus ankle osteoarthritis.Methods A retrospective analysis was done of the 21 patients with varus ankle osteoarthritis who had been treated at Department of Orthopaedics,Shanghai JiaoTong University Affiliated Sixth People's Hospital from January 2017 to December 2018.They were divided into 2 groups by their treatment methods.In the 9 patients treated by instrumentation with 3D-printed patient-specific guides,there were 6 males and 3 females with an age of 54.6±8.6 years,4 left and 5 right sides involved,and one case of Takakura stage 1,3 cases of Takakura stage 2 and 5 cases of Takakura stage 3a.In the 12 patients treated by conventional techniques,there were 7 males and 5 females with an age of 53.0±6.5 years,7 left and 5 right sides involved,and one case of Takakura stage 1,5 cases of Takakura stage 2 and 6 cases of Takakura stage 3a.The 3D printed guide group and the conventional group were compared in terms of operation time,intraoperative blood loss and frequency of intraoperative fluoroscopy,tibial anterior surface angle(TAS),talar tilt angle(TT),and tibial lateral surface angle(TLS).The differences in TAS,TT and TLS between pre-and post-operation in the 3D printed guide group were also evaluated.Results There were no significant differences in the preoperative general data between the 2 groups(P>0.05),indicating they were comparable.All the patients were available for follow-up for an average of 7.8 months(from 3 to 15 months).The 3D printed guide group incurred significantly shorter operation time(106.2±10.6 min),less intraoperative blood loss(207.2±16.0 mL)and lower fluoroscopy frequency(2±0)than the conventional osteotomy group(all P<0.01).The post-operative TAS(94.3°±3.2°)and TT(3.8°±0.8°)angles in the 3D guide group were significantly different from their preoperative values(84.6°±3.5°and 7.6°±1.6°)(P<0.01).The 3D printed guide group was not significantly different from the conventional group in postoperative TAS(94.3°±3.2°versus 92.4°±5.9°),TT(3.8°±0.8°versus 4.2°±1.1°)or TLS(83.7°±3.4°versus 84.2°±2.2°)angles(P>0.05).Conclusions Compared with conventional techniques,instrumentation with 3D-printed patient-specific guides can shorten operation time and reduce intraoperative blood loss and fluoroscopy frequency.The 3D printed patient-specific guides in osteotomy can facilitate accurate correction of varus deformity,leading to similar efficacy compared with conventional osteotomy.