3D截骨导板在合并股骨畸形膝关节骨性关节炎患者膝关节置换中的应用

Application of three-dimensional printed osteotomy guide plate in knee arthroplasty in osteoarthritis patients with concomitant femoral deformity

背景:对于复杂膝关节骨性关节炎,采用传统操作器械截骨定位技术易导致人工全膝关节置换假体位置安放不良。3D打印个性化截骨导板可使截骨与假体安放更加精准。目的:探讨个性化3D打印个性化截骨导板辅助下进行人工全膝关节置换治疗合并股骨畸形晚期膝关节骨性关节炎的早期临床疗效。方法:选择2016年6月至2020年5月广州医科大学附属第五医院收治的31例合并股骨畸形的重度膝关节骨性关节炎患者,男14例,女17例,年龄54-88岁,均在个性化3D打印个性化截骨导板辅助下行人工全膝关节置换治疗。治疗前及治疗后3 d,影像学测量股骨与胫骨机械轴夹角、股骨后髁角、髌骨横轴-股骨通髁线角;治疗前及治疗后6,12个月,评估患者美国特种外科医院(HSS)膝关节评分、目测类比评分与膝关节活动范围。结果与结论:①31例患者均获得12个月以上随访,试验及随访过程中未发生与植入材料相关的不良反应;②31例患者治疗后3 d的股骨与胫骨机械轴夹角、股骨后髁角、髌骨横轴-股骨通髁线角均低于治疗前(P均=0.000);③31例患者治疗后6,12个月的HSS膝关节评分与膝关节活动范围均高于治疗前(P<0.05),治疗后6,12个月的目测类比评分均低于治疗前(P<0.05);④结果表明,3D打印个性化截骨导板辅助下进行人工全膝关节置换治疗合并股骨畸形的晚期膝关节骨性关节炎,可缓解患者关节疼痛、改善关节功能、精确恢复下肢力线及股骨旋转对线、改善髌骨轨迹。

BACKGROUND:For complex knee osteoarthritis,traditional surgical instruments for osteotomy positioning technology can easily lead to poor placement of artificial total knee arthroplasty prostheses.Personalized three-dimensional printed osteotomy guide plate can achieve accurate osteotomy and prosthesis placement.OBJECTIVE:To investigate the early clinical effects of total knee arthroplasty with personalized three-dimensional printed osteotomy guide plates in the treatment of advanced knee osteoarthritis with femoral deformities.METHODS:Thirty-one patients with severe knee osteoarthritis combined with femoral deformity admitted to the Fifth Affiliated Hospital of Guangzhou Medical University from June 2016 to May 2020 were enrolled in the study.There were 14 males and 17 females,which aged 54-88 years old.A personalized three-dimensional printed osteotomy guide plate was used to assist in total knee arthroplasty surgery.Imaging measurement was conducted before treatment and at 3 days after treatment,to measure the included angle between femur and tibia mechanical axis,posterior condylar angle,patella transverse axis-femoral transepicondylar axis angle.American Hospital of Special Surgery score,Visual Analogue Scale score and range of motion of the knee joint were measured and assessed before and at 6 and 12 months after treatment.RESULTS AND CONCLUSION:All the 31 patients were followed up for more than 12 months,and no adverse advents related to implant materials occurred during the trial and follow-up.At 3 days after treatment,the included angles between the femur and tibia mechanical axis,posterior condylar angle,and patella transverse axis-femoral transepicondylar axis angles were lower than those before treatment in all the patients(all P=0.000).At 6 and 12 months after treatment,the American Hospital of Special Surgery score and the range of motion of the knee were higher than those before treatment in all the patients(P<0.05),while the Visual Analogue Scale scores were lower than those before treatment(P<0.05).Therefore,total knee arthroplasty with the assistance of three-dimensional printed personalized osteotomy guide plates can relieve joint pain,improve joint function,restore lower limb force lines and femoral rotation alignment,and improve patellar trajectory in patients with advanced knee osteoarthritis combined with femoral deformities.