模拟手术结合3D打印个性化导航模板在胫骨高位截骨术中的应用

Application of simulated surgery combined with 3D printing patient-specific instrumentation in high tibial osteotomy

目的评价模拟手术结合3D打印个性化导航模板(patient-specific instrumentation,PSI)应用于内侧开放楔形胫骨高位截骨术(high tibial osteotomy,HTO)其保膝治疗的精准性和安全性。方法回顾性分析2019年5月~2021年5月应用模拟手术结合3D打印PSI辅助内侧开放楔形HTO治疗的膝骨关节炎患者23例,其中男性2例,女性21例;年龄49~83岁,平均58.9岁;病程1~30年,平均6.3年。术前和术后测量胫骨近端内侧角(medialproximal tibial angle,MPTA)、髋-膝-踝角(hip-knee-ankle angle,HKA)、下肢负重线比率(weight bearing lineratio,WBL)、胫骨平台后倾角(posterior tibialslope angle,PTSA)和关节线会聚角(joint line convergence angle,JLCA)。记录患者术前和末次随访的VAS疼痛评分与AKS膝关节功能评分。结果所有患者获得随访,随访时间为7~19个月,平均11.8个月。术后测量结果:WBL(57.52±3.99)%,MPTA(90.77±0.68)°,HKA(182.84±1.58)°,JCLA(0.17±0.36)°,以上指标均显著优于术前(P<0.05);PTSA(8.22±1.17)°,比术前略有改善(P>0.05)。术后各影像学指标接近设计目标值(P>0.05),下肢力线矫正满意。末次随访时,截骨处均已愈合,VAS、AKS均较术前显著改善(P<0.05)。结论模拟手术结合3D打印PSI辅助内侧开放楔形HTO治疗膝骨关节炎,可获得满意矫正效果,精准度较高,疗效可靠。

Objective To investigate the accuracy and safety of simulated surgery combined with 3D printing patient-specific instrumentation(PSI)assisted medial open wedge high tibial osteotomy(HTO)in knee osteoarthritis.Methods The clinical data of 23 patients with knee osteoarthritis who were treated with simulated surgery combined with 3D printing PSI assisted medial open-wedge HTO between May 2019 and May 2021 were retrospectively analyzed.There were 2 males and 21 females,with an average age of 58.9 years(ranged 49-83 years).The disease duration ranged from 1 to 30 years,with an average of 6.3 years.Postoperatively,the weight bearing lineratio(WBL),medial proximal tibial angle(MPTA),hip-knee-ankle angle(PTSA),knee-ankle angle(HKA)and joint line convergence angle(JLCA)were measured and compared with the preoperative values,and the postoperative WBL,HKA,MPTA and actual correction angle of the lower limbs were compared with the preoperative design target values.At the final follow-up,the knee pain and function were assessed by VAS and AKS.Results All the patients were followed up for 7-19 months,with an average of 11.8 months.The postoperative WBL(57.52±3.99)%,MPTA(90.77±0.68)°,HKA(182.84±1.58)°,and JCLA(0.17±0.36)°were significantly improved compared with the preoperative values(P<0.05).There was no significant difference between preoperative and postoperative PTSA(P>0.05).The postoperative WBL,MPTA,HKA and actual correction angle of the lower limbs were slightly lower than the preoperative design target values,but the differences were not significant(P>0.05).At the final follow-up,the VAS scores were(0.78±0.52),which were significantly lower than the preoperative VAS scores(P<0.05).The AKS scores were(88.52±2.98),which were significantly higher than the preoperative AKS scores(P<0.05).Conclusions Simulated surgery combined with 3D printing PSI surgery assisted HTO is an effective method in knee osteoarthritis,which can achieve satisfactory clinical effects.