AI术前规划+3D打印导板行胫骨高位截骨术治疗膝骨关节炎的临床疗效

Clinical efficacy of AI preoperative planning+3D printed guide plate for high tibial osteotomy in the treatment of knee osteoarthritis

目的探究采用AI术前规划+3D打印导板(patient-specific instrumentation,PSI)辅助开放楔形胫骨高位截骨术(opening-wedge high tibial osteotomy,OWHTO)治疗膝骨关节炎(knee osteoarthritis,KOA)的精确性及术后临床结果。方法回顾性分析2020年1月至2022年9月在苏州市立医院接受OWHTO治疗的56例(56膝)骨关节炎患者的相关资料,其中25例(25膝)采用AI术前规划+3D打印导板辅助OWHTO(A组),31例(31膝)采用传统OWHTO(B组)。比较两组的术中透视次数、手术时间、术中失血量,依据术前术后影像学资料测量并比较两组患者下肢力线比率(weight bearing line ratio,WBLR)、术后WBLR与术前规划偏差值、胫骨近端内侧角(medial proximal tibial angle,MPTA)和胫骨平台后倾角(posterior tibial slope angle,PTSA)。术后随访时采用牛津膝关节评分(Oxford knee score,OKS)、Lysholm评分、膝关节活动度(range of motion,ROM)评估膝关节功能并记录并发症发生情况。结果两组患者随访12~30个月,平均随访(18.25±4.49)个月。A组的术中透视次数、手术时间、术中失血量均少于B组(P<0.05)。术后6个月随访时,A组OKS评分优于B组(P<0.05),而Lysholm评分、膝关节ROM比较差异无统计学意义(P>0.05);末次随访时两组患者OKS评分、Lysholm评分、膝关节ROM比较,差异均无统计学意义(P>0.05)。两组患者术后患肢完全负重时间比较差异无统计学意义(P>0.05)。两组患者并发症发生率比较,差异无统计学意义(P>0.05)。与术前相比,两组患者术后WBLR、MPTA均有显著改善(P<0.05),而PTSA无明显改变(P>0.05);两组患者术后WBLR、MPTA、PTSA比较,差异均无统计学意义(P>0.05),而术后WBLR与术前规划偏差值方面,A组显著低于B组(P<0.05)。结论采用AI术前规划+3D打印导板辅助OWHTO治疗KOA可以获得满意的临床结果,且相较于传统胫骨高位截骨术,手术精确性更高,并可减少术中透视次数、手术时间及失血量,简化手术流程。

Objective To explore the accuracy and clinical outcomes of opening-wedge high tibial osteotomy(OWHTO)assisted by AI preoperative planning and 3D printed patient-specific instrumentation(PSI)in the treatment of varus knee osteoarthritis(KOA).Methods A retrospective study was conducted on 56 patients(56 knees)who underwent OWHTO at Suzhou Municipal Hospital from January 2020 to September 2022.Among them,25 patients(25 knees)received OWHTO assisted by AI preoperative planning and 3D printed PSI(group A),and 31 patients(31 knees)received conventional OWHTO(group B).Times of intraoperative fluoroscopy,operation time and intraoperative blood loss were compared between the two groups.According to preoperative and postoperative imaging data,the weight bearing line ratio(WBLR),difference between postoperative WBLR and preoperative planned WBLR,medial proximal tibial angle(MPTA),and posterior tibial slope angle(PTSA)were measured and compared between the two groups.During postoperative follow-up,the Oxford knee score(OKS),Lysholm score and knee range of motion(ROM)were used to assess knee function,and the incidence of complications was recorded.Results All patients were followed up for(18.25±4.49)months(12-30 months).Times of intraoperative fluoroscopy,operation time and intraoperative blood loss in group A were less than those in group B(P<0.05).At 6 months after surgery,the OKS of group A was better than that of group B(P<0.05),while there was no significant difference in Lysholm score and ROM comparison(P>0.05).At the last follow-up,there was no significant difference in OKS,Lysholm score and ROM between the two groups(P>0.05).There was no significant difference in the time to return to full weight-bearing of the affected limb between the two groups(P>0.05).There was no significant difference in the incidence of complication rate between the two groups(P>0.05).Postoperative WBLR and MPTA significantly improved in both groups(P<0.05),while PTSA remained unchanged compared with the preoperative values(P>0.05).There was no significant difference in postoperative WBLR,MPTA,and PTSA between the two groups(P>0.05).The difference between postoperative WBLR and preoperative planned WBLR in group A was significantly lower than that in group B(P<0.05).Conclusion OWHTO assisted by AI preoperative planning and 3D printed PSI can achieve satisfactory clinical outcomes in the treatment of varus KOA,and the accuracy is higher compared with conventional OWHTO.It can also reduce intraoperative fluoroscopy times,operation time and blood loss,and simplify the surgical process.