3D打印截骨导板在膝外翻人工全膝关节置换术中的应用

Application of 3D printed osteotomy template in total knee arthroplasty for valgus knee

目的探讨3D打印截骨导板在膝外翻人工全膝关节置换术(TKA)中的应用效果。方法回顾性分析2016年3月至2018年2月期间在郑州市骨科医院关节Ⅰ科行TKA的21例膝外翻患者资料,男5例,女16例;年龄62~78岁,平均66.7岁。应用3D打印截骨导板辅助完成TKA,通过比较患者手术前、后股胫角、膝关节活动度、美国特种外科医院(HSS)膝关节评分标准评价应用效果。结果21例患者术后获10个月至4年(平均16.3个月)随访,术后切口均一期愈合。末次随访时,膝关节股胫角由术前的17.6°±5.7°改善为6.3°±1.2°,膝关节活动度由术前的71.3°±5.8°改善为102.4°±7.5°,HSS膝关节评分由术前的(38.2±5.7)分提高至(87.5±3.5)分,差异均有统计学意义(P<0.001)。末次随访时影像学评估显示假体稳定,无松动及骨溶解发生。结论3D打印截骨导板应用于膝外翻的人工全膝关节置换术,可提供精确的截骨,有效纠正力线,临床效果满意。

Objective To evaluate the application of 3D printed osteotomy template in total knee arthroplasty(TKA)for valgus knee.Methods A retrospective analysis was performed of the 21 patients with valgus knee who had undergone TKA at DepartmentⅠof Joint Surgery,Orthopaedics Hospital of Zhengzhou from March 2016 to February 2018.They were 5 males and 16 females,aged from 62 to 78 years(average,66.7 years).TKA was performed with the assistance of a 3D printed personalized osteotomy template for each patient.The efficacy of the personalized osteotomy templates was evaluated by comparing the femorotibial angle,knee range of motion,Hospital for Special Surgery(HSS)knee scores of the patients between preoperation and postoperation.Results The 21 patients were followed up for a mean duration of 16.3 months(range,from 10 months to 4 years).All incisions healed by the first intention.The last follow-ups showed that their preoperative femorotibial angle 17.6°±5.7°was improved significantly to 6.3°±1.2°,their preoperative knee range of motion 71.3°±5.8°increased significantly to 102.4°±7.5°,and their preoperative HSS scores 38.2±5.7 increased significantly to 87.5±3.5(P<0.001).Their radiographic evaluation at the last follow-up showed stable prosthetic components with no implant loosing or osteolysis.Conclusion A personalized 3D printed osteotomy template can be used in TKA for valgus knee,leading to accurate osteotomy,effective correction of mechanical alignment and satisfactory clinical outcomes.