关节镜结合3D打印技术治疗髌股关节炎的疗效观察

Effect of arthroscopy combined with 3D printing in the treatment of patel lofemoral arthritis

目的:观察关节镜结合3D打印技术治疗髌股关节炎的近期疗效。方法:选取19例患者,男6例,女13例,年龄31~66岁,平均年龄(46.4±7.6)岁,病程3~23个月,平均病程(16.1±8.9)个月。其中患病部位为右膝者有11例,为左膝者有6例,为双膝者有2例。术前制作3D打印模型,评估及测量髌股关节相关数据,术中以膝关节镜微创治疗髌股关节炎,依照术前规划打磨成形髌股关节骨性异常。然后比较手术前后患者的Lysholm评分、Kujala评分及视觉模拟评分法(Visual Analogue Scale,VAS)的评分。结果:术后所有患者的切口均一期愈合,无并发症发生,膝关节肿胀均在2~7 d后消失,无关节积血、积液发生,术后2~3 d下地活动,无深静脉血栓发生。术后4~6周,膝关节疼痛均有明显缓解,上楼、下蹲痛及功能受限均有不同程度的减轻。所有患者均获随访,随访时间8~33个月,平均(20.6±5.3)个月,术前VAS评分(5.79±1.63)分,术后6周VAS评分(3.12±1.05)分,差异有统计学意义(P<0.05);Lysholm评分术前(60.23±9.37)分,增加至术后6周随访时的(87.61±8.26)分,差异有统计学意义(P<0.05);Kujala评分术前(64.36±6.12)分,术后(83.76±4.53)分,差异有统计学意义(P<0.05)。髌骨3D模型测量提示,术前髌骨外移(4.51±1.67)mm,术后髌骨外移(1.12±0.45)mm,差异有统计学意义(P<0.05)。结论:膝关节镜结合3D打印技术治疗髌股关节炎的疗效较好,术前明确髌股关节的解剖结构,有利于术前诊断、手术规划,从而可使术中治疗更微创及有针对性。

Objective:To observe the short-term efficacy of arthroscopy combined with 3D printing in the treatment of patellofemoral arthritis.Methods:A total of 19 patients,6 males and 13 females,aged from 31 to 66 years,with an average age of(46.4±7.6)years,were selected.The disease lasted from 3 to 23 months,with an average course of(16.1±8.9)months.There were 11 cases of right knee,6 cases of left knee and 2 cases of both knees.Preoperative 3D printing model was made to evaluate and measure the relevant data of patellofemoral joint.During the operation,patellofemoral arthritis was treated with minimally invasive knee arthroscopy,and bone abnormalities of patellofemoral joint were formed by grinding according to the preoperative planning.Lysholm score,Kujala score,and Visual Analogue Scale(VAS)scores were compared before and after surgery.Results:The incisions of all patients healed in one stage without complications,knee swelling disappeared after 2-7 days,no joint blood and fluid accumulation,ground movement 2 to 3 days after operation,and no deep venous thrombosis.4~6 weeks after operation,the knee pain was significantly relieved,and the pain of upstairs and squatting and function limitation were alleviated to varying degrees.All patients were followed up for 8-33 months,with an average of(20.6±5.3)months.The preoperative VAS score was(5.79±1.63)points,and the postoperative VAS score was(3.12±1.05)points at 6 weeks,the difference was statistically significant(P<0.05).Lysholm score increased from 60.23±9.37 points before surgery to 87.61±8.26 points 6 weeks after surgery,with statistical significance(P<0.05).Kujala scores were 64.36±6.12 points before operation and 83.76±4.53 points after operation,and the difference was statistically significant(P<0.05).3D model measurement of patella showed that the patella migrated outwards(4.51±1.67)mm before surgery and(1.12±0.45)mm after surgery,the difference was statistically significant(P<0.05).Conclusion:Knee arthroscopy combined with 3D printing has a good therapeutic effect in the treatment of patellofemoral arthritis.Preoperative determination of the anatomical structure of patellofemoral joint is conducive to preoperative diagnosis and surgical planning,thus making the intraoperative treatment more minimally invasive and targeted.