传统技术和3D打印个性化截骨导板辅助下全膝关节置换术治疗膝骨关节炎的对比研究

A comparative study of total knee replacement assisted by traditional technology versus 3D printing personalized osteotomy guide in the treatment of knee osteoarthritis

目的:探讨采用传统技术和3D打印个性化截骨导板辅助下的全膝关节置换术(TKA)治疗膝骨关节炎的差别。方法:收集2016年2月至2021年2月收治的60例行单侧TKA治疗的膝骨关节炎患者作为研究对象。采用3D打印个性化截骨导板实施TKA 30例,采用传统手术器械30例。3D打印组包括男14例,女16例,年龄51~82岁,平均(66.7±7.7)岁;侧别:左18例,右12例。传统手术组包括男10例,女20例,年龄44~81岁,平均(68.2±7.3)岁;侧别:左11例,右19例。记录并比较两组患者的手术时间,术中及术后失血量,住院时间,术后1、3、12个月的KSS疼痛评分及功能评分。结果:3D打印组平均手术时间为(57.8±8.5)min,与传统手术组比较差异有统计学意义(t=-7.987,P<0.05);术中出血量为(32±7)mL,与传统手术组比较差异无统计学意义(t=-1.925,P>0.05);术后24 h出血量为(96±7)mL,与传统手术组比较差异有统计学意义(t=-14.595,P<0.05);住院时间为(10.2±1.4)d,与传统手术组比较差异无统计学意义(P>0.05);术后1个月KSS疼痛评分为(86.9±5.0)分、功能评分为(83.5±6.3)分,与传统手术组比较差异有统计学意义(t=7.066,P<0.05;t=5.401,P<0.05);术后3个月及12个月的KSS疼痛评分为(95.0±1.7)分和(95.1±2.2)分,功能评分为(85.0±6.2)分和(86.5±6.3)分,与传统手术组比较差异无统计学意义(P>0.05)。结论:3D打印个性化截骨导板辅助下的TKA可缩短手术时间,减少术后出血量,更有利于患者早期恢复关节功能。

Objective:To investigate the difference between conventional and 3D print-assisted total knee arthroplasty(TKA)in the treatment of knee osteoarthritis(KOA).Methods:A total of 60 patients with unilateral KOA undergoing TKA from February 2016 to February 2021 were enrolled in this study.The patients were divided into 3D printing personalized osteotomy guide group and traditional surgical instrument group(n=30).In the 3D printing personalized osteotomy guide group,there were 14 males and 16 females with an mean age of(66.7±7.7)years(range,51-82 years);the left side was involved in 18 patients and the right was involved in 12 patients.The traditional surgical instrument group included 10 males and 20 females,aged 44-81 years,with an average age of(68.2±7.3)years.The left side was involved in 11 patients and the right was involved in 19 patients.Operative time,intraoperative and postoperative blood loss,length of stay,and KSS pain and function scores at 1,3 and 12 months after surgery were recorded and compared between the two groups.Results:The operative time of the 3D printing personalized osteotomy guide group was(58±8)min,which was significantly less than that of the traditional surgical instrument group(t=-7.987,P<0.05).Intraoperative blood loss of the 3D printing personalized osteotomy guide group was(32±7)mL,and there was no significant difference in the intraoperative blood loss between the two groups(t=-1.925,P>0.05).The amount of blood loss within 24 h after operation was(96±7)mL,which was significantly less than that of the traditional surgical instrument group(t=-14.595,P<0.05).The length of hospital stay was(10.2±1.4)d in the 3D printing personalized osteotomy guide group,which had no statistical significance compared with the traditional surgical instrument group(t=-1.986,P>0.05).One month after surgery,KSS pain score and function score were 86.9±5.0 and 83.5±6.3 in the 3D printing personalized osteotomy guide group,respectively,which were significantly higher than those of the traditional surgical instrument group(t=7.066,P<0.05;t=5.401,P<0.05).KSS pain score at 3 months and 12 months after surgery was 95.0±1.7 and 95.1±2.2 in the 3D printing personalized osteotomy guide group,and function score was 85.0±6.2 and 86.5±6.3,which were not significantly different from those in the traditional surgical instrument group(P>0.05).Conclusions:TKA assisted by 3D printing technology can shorten operation time and reduce postoperative bleeding,which is more conducive to the early recovery of joint function in TKA patients.