膝骨性关节炎3D打印导板与传统胫骨高位截骨比较

3D-printed patient-specific instrumented high tibial osteotomy versus traditional counterpart for medial knee osteoarthritis

[目的]评价3D打印个性化导板(patient-specific instrumentation, PSI)辅助胫骨高位截骨(high tibial osteotomy,HTO)治疗内翻型膝骨关节炎(knee osteoarthritis, KOA)的精准度和疗效。[方法]回顾性分析2019年1月—2021年2月在本院骨科行内侧开放楔形HTO治疗的35例KOA患者的临床资料。根据医患沟通结果,17例采用3D打印PSI辅助截骨,18例采用传统方法截骨。比较两组围术期情况、随访和影像资料。[结果]两组患者均顺利完成手术,3D组手术切口总长度、手术时间、术中失血量、术中透视次数、下地行走时间和术后住院时间均显著优于传统组(P<0.05)。两组早期并发症发生率的差异无统计学意义(P>0.05)。随访时间平均(14.34±2.03)个月,两组恢复完全负重活动时间差异无统计学意义(P>0.05)。随着时间推移,两组患者的VAS评分、HSS评分和膝关节伸屈ROM均显著改善(P<0.05)。影像方面,与术前相比,术后两组患者的WBLR和MPTA均显著增加(P<0.05),而PTS无明显改变(P>0.05),膝骨关节炎K-L分级显著改善(P<0.05)。术后6、12个月随访时,3D组的WBLR和MPTA均显著大于传统组(P<0.05),两组间K-L评级的差异无统计学意义(P>0.05)。至末次随访时,所有患者截骨均已愈合,两组愈合时间的差异无统计学意义(P>0.05)。[结论]相比传统方法截骨,3D打印PSI辅助的内侧开放楔形HTO,术中透视次数更少,手术时间更短,下肢力线矫正更精确。

[Objective] To investigate the accuracy and efficacy of 3D printed patient-specific instrumented(PSI) high tibial osteotomy(HTO) for medial knee osteoarthritis(KOA), by comparing with traditional HTO. [Methods] A retrospective study was conducted on 35 patients who underwent medial open wedge HTO for medial KOA in our department from January 2019 to February 2021. Based on preoperative doctor-patient communication, 17 patients received 3D printed PSI HTO(the 3D group), while the remaining 18 patients underwent the traditional HTO(the traditional group). The documents regarding to perioperative period, follow-up and radiographs were compared between the two groups. [Results] All patients in both groups had the surgical procedures performed smoothly. The 3D group proved significantly superior to the traditional group in terms of total length of surgical incision, operative time, blood loss, fluoroscopy times, walking time and postoperative hospital stay(P<0.05), whereas without significant differences between them in the occurrence of early complications(P>0.05). All the patients were followed up from 12 to 18 months with a mean of(14.34±2.03) months. The 3D group resumed full weight-bearing activity slightly earlier than the traditional group, despite of no statistically significant difference between them(P>0.05).The VAS and HSS scores and knee extension range of motion(ROM) in both groups significantly improved over time(P<0.05), which were not statistically significant between them at any matching time point(P>0.05). Radiographically, the weight bearing line ratio(WBLR), medial proximal tibial angle(MPTA) and Kellgren-Lawrence(K-L) classification significantly improved, whereas the posterior tibial slope(PTS) remained unchanged in both groups postoperatively compared with those preoperatively(P<0.05). At 6 and 12 months after surgery,the 3D group was significantly superior to the traditional group in terms of WBLR and MPTA(P<0.05), whereas no a statistical difference in K-L grade between them(P>0.05). By the time of latest follow-up, bony healing achieved in all the patients, which was not significantly different between the two groups(P>0.05). [Conclusion] Compared with conventional osteotomy, 3D printed PSI OWHTO has advantages of fewer intraoperative fluoroscopy, shorter operative time and more accurate alignment of lower extremity correction.