3D打印个体化截骨导板辅助胫骨高位截骨术治疗内翻型膝骨关节炎精准性的临床疗效

Accuracy of high tibial osteotomy assisted by 3D printing patient-specific instrumentation guider in the treatment of varus knee osteoarthritis

目的:观察3D打印个体化截骨导板(patient-specific instrumentation,PSI)辅助胫骨高位截骨术(high tibial osteotomy,HTO)治疗内翻型膝骨关节炎的精准性。方法:2018年5月至2020年12月采用3D打印PSI辅助内侧开放胫骨高位截骨术治疗15例膝内翻畸形合并骨性关节炎患者,通过术前CT三维重建模拟规划截骨手术时的胫骨近端内侧角(medial proximal tibial angle,MPTA)、下肢负重线比率(weight bearing line,WBL)落点、撑开高度、胫骨后倾角(posterior tibial slope,PTS)、关节线交角(joint line convergence angle,JLCA),并与截骨术后实际测量值进行比较。结果:术前规划与术后测量的MPTA、WBL落点、撑开高度、PTS及JLCA之间差异均无统计学意义,一致性良好。所有患者伤口均Ⅰ期愈合,无并发症。结论:3D打印PSI辅助胫骨高位截骨术能够增加下肢力线矫正的精准性,降低PTS、JLCA等变化的风险,提高疗效。

Objective:To observe the accuracy of 3D printing patient-specific instrumentation(PSI)guider assisted high tibial osteotomy(HTO)in the treatment of varus knee osteoarthritis.Methods:From May 2018 to December 2019,15 patients with varus knee osteoarthritis were treated with 3D printing PSI guider assisted medial opening wedge high tibial osteotomy.The preoperative medial proximal tibial angle(MPTA),weight bearing line(WBL)point,distraction height,posterior tibial slope(PTS),and joint line convergence angle(JLCA)were simulated and measured by CT three-dimensional reconstruction,which were compared with the actual measurement value after osteotomy.Results:There was no significant difference between the preoperative and postoperative measurement of MPTA,WBL point,distraction height,PTS and JLCA,which were consistent.All patients’wounds were healed in the first stage without complications.Conclusions:3D printing PSI guider assisted HTO can enhance accuracy in correcting lower limb alignment,reduce the risk of changes in PTS,JLCA,etc and improve the curative effect.