3D打印截骨导板辅助下的TKA手术在河西走廊地区的临床应用

Clinical application of TKA surgery assisted by 3D printing osteotomy guide plate in Hexi Corridor

目的比较3D打印截骨导板辅助全膝关节置换(total knee arthroplasty,TKA)与传统手术方式行TKA的临床效果差异,探讨应用3D打印个性化截骨技术在TKA中的临床应用价值。方法将2015年10月~2018年6月间行TKA的120例(136膝)患者,随机分成3D组和传统组,3D组60例(70膝)采用3D打印截骨导板辅助膝关节置换手术,传统组60例(66膝)采用传统的膝关节置换方法。术前两组患者年龄、性别、KSS(knee society score)评分,均无统计学差异(P>0.05)。记录手术时间,术中实际股骨远端、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),并进行统计学分析,末次随访时行KSS评分。结果术后随访9~32个月,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无统计学差异(P>0.05);3D导板组的手术时间、MFTA值、STCA值与传统组相比差异有统计学意义(P<0.05);末次随访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3D打印个性化截骨技术简化了TKA手术步骤,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 differences of clinical efficacy between 3 D printing technology surgical method and conventional surgical method in total knee arthroplasty(TKA),and to investigate the application of 3 D printing osteotomy technique assisted TKA in the treatment of knee arthropathy.Methods From October 2015 to June 2018,136 knees of 120 patients with TKA were randomly divided into two groups,a 3 D group and a conventional group.The 60 patients in the 3 D group(70 knees)used 3 D printing osteotomy guide plate to assist the TKA operation.The 60 patients(66 knees)in the conventional group adopted the traditional TKA method over the same period.There were no significant differences in age,gender and knee society score grade among two groups before operation(P>0.05).Operation time,the actual distal femur and the osteotomy data of proximal tibia during operation were recorded.The mechanical femur tibia angle(MFTA),the sagittal tibia plateau caster angle(STCA)of two groups after operation were measured by X-ray and were analyzed statistically,and the knee society score(KSS)was recorded and compared between the two groups at the end of the follow-ups.Results All patients were followed up for 9~32 months,no infection,prosthesis loosening or motion was observed in two groups.No significant differences in the distal femur and the osteotomy data of proximal tibia were found between the planned value in 3 D group and the actual value in the operation(P>0.05).There were statistical significances in operation time,MFTA value and STCA value between 3 D group and conventional group(P<0.05).The 3 D group had better clinical and functional grade in KSS than the conventional group during the last follow-ups.and there were statistical significances(P<0.05).Conclusion The 3 D printing technique can simplify the operation procedure,improve the surgical accuracy and the clinical efficacy,making it worthy of further promotion.