3 D打印导板在肿瘤性长骨畸形胫骨截骨矫形中的应用

Application of 3 D printed guide plate in tibial osteotomy for neoplastic long bone deformity

目的:探讨3D打印导板在肿瘤性长骨畸形胫骨截骨矫形中的临床应用。方法:回顾性分析2021年6月至2022年12月收治的52例肿瘤性长骨畸形患者的病历资料,所有患者均采用3D打印导板行截骨矫形内固定治疗。术前及术后1周拍摄下肢全长及膝关节负重正侧位X线片,测量负重线比率(WBL)、关节线相交角(JLCA)、胫骨近端内侧角(MPTA)、胫骨后倾角(PTS)。术前、术后6个月、术后1年采用Lysholm评分评估下肢功能。结果:所有患者下肢畸形均得到有效矫正。术后1周,WBL和MPTA较术前明显提升(t=-7.294,P<0.05;t=-4.153,P<0.05),JLCA较术前明显降低(t=-1.463,P<0.05),术前和术后PTS无明显变化(t=2.284,P>0.05)。术后6个月Lysholm评分较术前明显提高(t=-5.087,P<0.05),而术后6个月与术后1年Lysholm评分相比无明显变化(t=1.245,P>0.05)。结论:采用3D打印导板辅助肿瘤性长骨畸形截骨矫形,可有效纠正下肢力线,改善膝关节功能。

Objective:To investigate the clinical effect of 3D printed guide plate in tibial osteotomy for neoplastic long bone deformity.Methods:Clinical data of 52 patients with neoplastic long bone deformity who were treated with osteotomy and orthopaedic internal fixation using 3D printed guide plate from June 2021 to December 2022 were retrospectively analyzed.Full-length radiographs were taken at the standing position of the lower limbs and anterolateral radiographs at the bearing position before surgery and 1 week after surgery.The weight bearing line(WBL)ratio,joint line conergence angle(JLCA)of the lower limbs,medial proximal tibial angle(MPTA),and posterior tibial slope(PTS)were measured.Limb function was evaluated by Lysholm score before surgery,6 months after surgery and 1 year after surgery.Results:The lower limb deformity was effectively corrected in all the patients.Compared with preoperative ones,WBL and MPTA were significantly increased 1 week after surgery(t=-7.294,P<0.05;t=-4.153,P<0.05),JLCA was significantly decreased(t=-1.463,P<0.05),and PTS had no significant changes(t=2.284,P>0.05).Lysholm score at 6 months and 1 year after surgery was significantly higher than that before surgery(t=-5.087,P<0.05;t=-3.237,P<0.05),and there was no significant change at 6 months after surgery compared with 1 year after surgery(t=1.245,P>0.05).Conclusions:The use of 3D printed guide plate to assist osteotomy and orthosis of neoplastic long bone deformity can effectively correct lower limb alignment and improve knee joint function.