3D打印导板辅助前交叉韧带重建术中骨隧道定位的准确性

The accuracy of bone tunnel positioning assisted with 3D printed positioning guide during anterior cruciate ligament reconstruction

目的探讨定制3D打印定位导板对提高关节镜下前交叉韧带重建术中骨隧道定位准确性的影响。方法40例前交叉韧带断裂患者随机分为2组,每组各20例。一组使用3D打印导板,另一组接受传统手术,术中胫骨端用羟基磷灰石挤压螺钉固定,股骨端用微孔钢板悬吊固定,记录两组的手术时间。术后随访,常规行膝关节正侧位检查,胫骨端隧道评估使用Klos测量法,股骨端采用Amis法,评估两组患者术前术后的Lysholm评分、Tegner评分,并进行统计学分析。结果3D打印组平均手术时间为(52.9±3.8)min,传统手术组为(66.3±4.5)min,差异有统计学意义(P<0.05)。3D打印组的Amis法、Klos法评分分别为(45.6±1.5)%、(62.7±3.3)%,传统手术组分别为(41.4±1.4)%和(57±2.6)%,差异均有统计学意义(P<0.05)。3D打印组的Lysholm评分由术前(57.45±3.73)分提高至术后(96.42±2.08)分,传统手术组由术前(57.06±5.61)分提高至术后(96.12±1.99)分,组间差异无统计学意义(P>0.05)。3D打印组的Tegner评分由术前(3.45±0.99)分提高至术后(5.95±0.82)分,传统手术组由术前(3.50±0.96)分提高至术后(6.10±0.78)分,组间差异无统计学意义(P>0.05)。结论3D打印导板辅助可以明显缩短手术时间、提高隧道定位准确度,患者膝关节功能恢复情况与传统手术相当。

Objective To investigate the effect of customized 3D printed positioning guide on improving the accuracy of bone tunnel positioning during anterior cruciate ligament reconstruction under arthroscope.Methods Forty patients with anterior cruciate ligament rupture were randomly divided into two groups with 20 patients in each group.One group was treated with a 3D—printed guide plate,the other group was treated with traditional surgery,during which the tibia was fixed with hydroxyapatite extrusion screw and the femur was suspended with microporous plate.The operative time of the two groups was recorded.During postoperative follow-up,knee joint anteroposterior and lateral examination was routinely performed,tibial tunnel was assessed by Klos measurement,and femoral end was assessed by Amis.Lysholm score and Tegner score were evaluated before and after surgery in both groups,and statistical analysis was performed.Results The average operation time of the 3D printing group was(52.9±3.8)minutes,and the average operation time of the traditional operation group was(66.3±4.5)minutes,the difference was statistically significant.The Amis and Klos scores of the 3D printing group were(45.6±1.5)%and(62.7±3.3)%,respectively,and those of the traditional surgery group were(41.4±1.4)%and(57±2.6)%,respectively,with statistically significant differences(P<0.05).The Lysholm score of the 3D printing group increased from(57.45±3.73)points before surgery to(96.42±2.08)points after surgery,and the Lysholm score of the traditional surgery group increased from(57.06±5.61)points before surgery to(96.12±1.99)points after surgery,with no statistical significance(P>0.05).The Tegner score of the 3D printing group increased from(3.45±0.99)points before surgery to 5.95±0.82 points after surgery,and that of the traditional surgery group increased from 3.50±0.96 points before surgery to(6.10±0.78)points after surgery,with no statistical significance(P>0.05).Conclusion The 3D printed guide can significantly shorten the operation time and improve the accuracy of tunnel positioning,and the patient's knee function recovery is comparable to that of traditional surgery.