3D打印导板辅助定位在外踝韧带重建术治疗慢性踝关节不稳中的应用研究

Application of a 3D printed guide plate in reconstruction of the lateral malleolar ligament for chronic ankle instability

目的探讨3D打印导板辅助定位重建外踝韧带治疗慢性踝关节不稳的疗效。方法回顾性分析2020年3月至2022年3月联勤保障部队第九八五医院骨科收治的33例踝关节不稳定患者资料。全部为男性,年龄25.2(19.0,30.0)岁。根据治疗方式不同将患者分为3D打印组(13例,采用3D打印导板辅助定位重建外踝韧带)和透视组(20例,采用C型臂X线机透视定位重建外踝韧带),所有患者均接受经皮外踝韧带自体股薄肌腱重建术。比较两组患者的手术时间、术中X线透视次数,术前、末次随访时患者美国足踝外科协会(AOFAS)踝-后足评分、足踝结果分数(FAOS)、距骨前移距离、距骨倾斜角度,并观察并发症的发生情况。结果两组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。所有患者术后随访(14.5±5.5)个月。3D导板组手术时间(34.2±6.5)min显著短于透视组(50.4±7.1)min,X线透视次数(1.4±0.5)次显著少于透视组(3.6±0.7)次,差异均有统计学意义(P<0.05)。所有患者末次随访时AOFAS踝-后足评分、FAOS评分、距骨前移距离、踝关节内翻角度均较术前显著改善,差异均有统计学意义(P<0.05)。两组患者间末次随访时AOFAS踝-后足评分、FAOS评分、距骨前移距离、距骨倾斜角度比较差异均无统计学意义(P>0.05)。所有患者无医源性骨折、韧带松动、切口感染、皮肤坏死、内置物脱落等并发症发生。结论与C型臂X线机透视定位比较,3D打印导板辅助定位下重建外踝韧带治疗慢性踝关节不稳疗效确切,可明显缩短手术时间、减少患者术中X线透视次数。

ObjectiveTo investigate the efficacy of a 3D printed guide plate in assisting reconstruction of the lateral malleolar ligament for chronic ankle instability.MethodsThe clinical data were retrospectively analyzed of the 33 patients who had been treated for ankle instability from March 2020 to March 2022 at Department of Orthopaedics,The 985 Hospital of Joint Logistics Support Force of PLA.All patients were male,aged 25.2(19.0,30.0)years.They were divided into 2 groups according to whether a 3D printed guide plate was used or not.In the 3D printing group of 13 cases,a 3D printed guide plate was used to assist positioning in reconstruction of the lateral malleolar ligament;in the fluoroscopy group of 20 cases,a C-arm machine was used to assist positioning in reconstruction of the lateral malleolar ligament.All patients underwent percutaneous reconstruction of the lateral malleolar ligament with the gracilis tendon.The 2 groups were compared in terms of operation time,fluoroscopy frequency,and the American Orthopaedic Foot&Ankle Society(AOFAS)ankle-hindfoot score and Foot&Ankle Outcome Score(FAOS)before operation and at the last follow-up.The incidence of postoperative complications were observed.ResultsThere was no statistically significant difference in the preoperative general data between the 2 groups,indicating comparability(P>0.05).The follow-up duration for all was(14.5±5.5)months.For the 3D printing group,the operation time was(34.2±6.5)min,significantly shorter than that for the fluoroscopy group[(50.4±7.1)min],and the fluoroscopy frequency was(1.4±0.5)times,significantly lower than that for the fluoroscopy group(3.6±0.7)times(P<0.05).At the last follow-up,the AOFAS ankle-hindfoot score,FAOS,talus anterior displacement,and ankle varus angle were significantly improved in all patients compared with preoperation(P<0.05).There was no statistically significant difference between the 2 groups at the last follow-up in AOFAS score,FAOS,talus anterior displacement,or talus tilt angle(P>0.05).None of the patients had such complications as iatrogenic fracture,ligament loosening,incision infection,skin necrosis,or implant detachment.ConclusionCompared with a C-arm X-ray machine,a 3D printed guide plate can have a definite effect on the positioning in reconstruction of the lateral malleolar ligament for chronic ankle instability,leading to significantly shortened operation time and reduced fluoroscopy frequency.