3D打印个性化定制导板辅助在复杂膝关节置换中的应用

Complex total knee arthroplasty assisted by a 3D printed patient-specific guider

目的探讨3D打印个性化定制导板(PSG)在复杂全膝关节置换术(TKA)中的应用效果。方法回顾性分析2016年1月至2019年10月南京医科大学附属南京医院骨科采用人工TKA治疗的44例复杂膝关节畸形(含关节外畸形)患者资料。根据术前是否应用3D打印PSG将患者分为3D打印个性化导板(3D-PSG)组和常规组(21例)。3D-PSG组23例,男11例,女12例;年龄为(63.7±10.2)岁(53~81岁)。常规组21例,男10例,女11例;年龄为(64.2±12.1)岁(51~79岁)。3D-PSG组患者术前将CT扫描数据进行三维重建,由此计算下肢骨骼解剖参数并设计3D导板,将导板STL文件导入3D打印机制造导板,导板辅助完成TKA。常规组:采用标准的TKA。记录3D-PSG组的TKA手术方案,并与术中实际结果进行比较。比较两组患者的手术时间、术中出血量、术后引流量、住院时间及术后的疼痛视觉模拟评分(VAS)、膝关节功能评分(KSS)、冠状面髋-膝-踝角(HKA)、冠状面股骨组件角(FFC)、冠状面胫骨组件角(FTC)、矢状面股骨组件屈曲角(LFF)、矢状面胫骨组件角(LTC)等下肢力线偏差值。结果两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。3D-PSG组术前规划与术中使用的股骨髁假体型号[(3.4±1.1)、(3.5±0.9)]、胫骨平台假体型号[(3.1±0.9)、(3.3±1.2)]、垫片厚度[(10.6±3.2)mm、(10.9±4.7)mm]比较差异均无统计学意义(P>0.05)。44例患者术后平均随访10.8个月(7~13个月)。3D-PSG组的手术时间[(65.7±10.5)min]、术中出血量[(19.8±7.3)mL]、术后引流量[(124.6±27.9)mL]、住院时间[(7.3±2.5)d]均少于常规TKA组[(82.4±11.7)min、(86.5±35.7)mL、(154.6±21.3)mL、(10.6±3.1)d],3D-PSG组术后1 d、1周、2周VAS评分及KSS评分较常规组占优势,3D-PSG组的HKA、FFC、FTC、LFF、LTC接近理想值的患者数量较常规组多,差异均有统计学意义(P<0.05)。结论3D打印个性化定制导板能够显著提高复杂膝关节置换术精准度,减少手术时间,提高手术疗效。

Objective To explore the application of a 3D printed patient-specific guider(3D-PSG)in complex total knee arthroplasty(TKA).Methods A retrospective analysis was performed of the data of 44 patients who had received complex artificial TKA for articular and extra-articular deformities of the knee from January 2016 to October 2019 at Department of Orthopaedic Surgery,Nanjing First Hospital.According to whether a 3D-PSG had been applied,the patients were divided into 2 groups.In the 3D-PSG group of 23 patients,there were 11 males and 12 females,with an age of 63.7 years±10.2 years(from 53 to 81 years);in the conventional group of 21 cases,there were 10 males and 11 females,with an age of 64.2 years±12.1 years(from 51 to 79 years).In the 3D-PSG group,the preoperative CT data were 3D reconstructed for measurement of a full lower limb and design of a 3D-PSG and TKA was assisted by a 3D-PSG which had been manufactured by a 3D printer using the STL files of the 3D-PSG imported.In the conventional group TKA was performed in a standard manner.In the 3D-PSG group,the TKA surgical parameters in the preoperative plan were compared with actual surgical measurements.The 2 groups were compared in terms of operation time,intraoperative blood loss,postoperative drainage volume,length of hospital stay,visual analogue scale(VAS),Knee Society Score(KSS),hip knee ankle(HKA),frontal femoral component(FFC),frontal tibial component(FTC),lateral femoral flexion(LFF)and lateral tibial component(LTC).Results There were no significant differences between the 2 groups in the preoperative general data,showing comparability(P>0.05).In the 3D-PSG group,no significant differences were found between preoperative parameters designed and actual intraoperative measurements in the prosthetic type of femoral condyle(3.4±1.1 versus 3.5±0.9)or of tibial plateau(3.1±0.9 versus 3.3±1.2),or in the filler thickness(10.6 mm±3.2 mm versus 10.9 mm±4.7 mm)(P>0.05).The 44 patients were followed up for an average of 10.8 months(from 7 to 13 months).The 3D-PSG group had significantly less operation time(65.7 min±10.5 min),intraoperative blood loss(19.8 mL±7.3 mL),postoperative drainage volume(124.6 mL±27.9 mL)and hospital stay(7.3 d±2.5 d)than the conventional group(82.4 min±11.7 min,86.5 mL±35.7 mL,154.6 mL±21.3 mL and 10.6 d±3.1 d)(P<0.05).The VAS and KSS scores at postoperative day 1,week 1 and week 2 in the 3D-PSG group were significantly better than those in the conventional group(P<0.05).Significantly more patients in the 3D-PSG group achieved approximately ideal values in HKA,FFC,FTC,LFF and LTC than those in the conventional group(P<0.05).Conclusion A 3D printed patient-specific guider may improve surgical accuracy,reduce operation time and achieve better surgical outcomes in complex total knee arthroplasty.