复杂下肢畸形3D打印辅助一期截骨全膝置换术

3D printed one-stage osteotomy and total knee arthroplasty for complex lower limb deformities

[目的]介绍复杂下肢畸形3D打印辅助一期截骨矫正全膝置换(total knee arthroplasty, TKA)的手术技术和初步临床效果。[方法] 2019年11月—2020年11月采用上述术式治疗复杂下肢畸形患者3例。术前将双下肢骨骼三维CT数据导入计算机,根据关节外畸形和关节畸形设计制作截骨导板,并模拟手术。术中按照计划在关节外畸形的旋转中心(center of rotation, COR)安装截骨导板进行关节外截骨矫形,钢板固定。对伴关节畸形者,采用3D打印导向器骨端截骨,安装TKA假体。[结果]所有患者均顺利完成手术,术中无血管、神经损伤等严重并发症。随访时间(20.00±6.93)个月,随时间推移,KSS评分、膝伸屈ROM均显著增加(P<0.05)。术后机械轴偏移(mechanical axis deviation, MAD)较术前明显改善(P<0.05)。术后髋-膝-踝角(hip-knee-ankle angle, HKA)较术前明显改善,但手术前后比较差异无统计学意义(P>0.05)。[结论] 3D打印辅助截骨全膝关节置换治疗合并复杂下肢畸形终末膝病可提高矫形的精准性,获得良好的临床疗效。

[Objective] To introduce the surgical techniques and preliminary clinical results of 3D printed osteotomy and total knee arthroplasty(TKA) for complex lower limb deformities. [Methods] From November 2019 to November 2020, 3 patients received aforesaid procedures for complex lower limb deformities. The CT data of lower limb were processed by computer to design extraarticular osteotomy guider and TKA osteotomy guider, and mimic the operations. Intraoperatively, the extraarticular osteotomy guider was placed on the center of rotation(COR) of the extraarticular deformity as planned to conduct the extraarticular osteotomy and correction with plate fixation. For the patients with articular deformities, the 3D printed TKA guider was used for femoral or tibial end osteotomy, followed by the prosthetic installation. [Results] All the patients were successfully operated on without any serious complications such as vascular and nerve injury. As time went during the follow-up period lasted for(20.00±6.93) months, KSS score and knee extension-flexion ROM significantly increased(P<0.05). Radiographically, the mechanical axis deviation(MAD) significantly improved postoperatively compared with those preoperatively(P<0.05). The hip-knee-ankle angle(HKA) improved postoperatively compared with those preoperatively, but there was no significant difference between them(P>0.05). [Conclusion] The 3D printed one-stage osteotomy and TKA do correct deformities accurately and achieve good clinical outcomes for the knee end-stage arthropathy complicated with complex extraarticular and articular deformities..