3D打印个体化截骨导板联合运动力学对线全膝关节置换术的临床疗效

Clinical efficacy of three-dimensional printed individualized osteotomy guides combined with kinematic alignment in total knee arthroplasty

目的:探讨3D打印个体化截骨导板联合运动力学对线技术在全膝关节置换术(TKA)中的应用效果。方法:回顾性分析2020年1月至2023年1月收治的80例膝骨关节炎患者,其中采用3D打印个体化截骨导板联合运动力学对线技术行单侧TKA的42例患者为运动力学组,采用3D打印个体化截骨联合机械力学对线技术行单侧TKA的38例患者为机械力学组。比较两组患者围手术期指标[包括手术时间、切口长度、总失血量(术中出血量+术后失血量)、首次下地行走时间、切口愈合情况、住院时间、疼痛视觉模拟评分(VAS)、美国膝关节协会评分(KSS)、膝关节伸-屈活动度、胫股角(FTA)]。结果:术后随访时间为12~16个月,平均(13.1±2.8)个月。两组患者术中无神经血管损伤,术后无感染、深静脉血栓等严重并发症。所有患者手术切口均一期愈合。运动力学组患者首次下地行走时间、住院时间短于机械力学组,差异有统计学意义(P均<0.05);两组患者手术时间、切口长度、总失血量比较,差异无统计学意义(P>0.05)。术前,两组患者VAS评分、KSS、膝关节伸-屈活动度、FTA比较,差异无统计学意义(P>0.05)。术后1个月,运动力学组患者VAS评分低于机械力学组,KSS高于机械力学组,膝关节伸-屈活动度大于机械力学组,FTA小于机械力学组,差异有统计学意义(P均<0.05)。术后6个月和末次随访时,运动力学组患者FTA小于机械力学组,差异有统计学意义(P<0.05);两组患者VAS评分、KSS、膝关节伸-屈活动度比较,差异无统计学意义(P>0.05)。结论:3D打印个体化截骨导板联合运动力线对线TKA治疗终末期膝骨关节炎患者的临床疗效满意,具有精准性高、安全性好的优点。

Objective:To investigate the efficacy of three-dimensional(3D)printed individualized osteotomy guides combined with kinematic alignment in total knee arthroplasty(TKA).Methods:A retrospective analysis was conducted on 80 patients with knee osteoarthritis treated from January 2020 to January 2023.Patient were divided into two groups according to their preference for surgical method,42 patients who underwent TKA using 3D printed individualized osteotomy guides combined with kinematic alignment(kinematic group)and 38 patients who underwent unilateral TKA using 3D printed individualized osteotomy guides combined with mechanical alignment(mechanical group).The following perioperative indicators were compared between the two groups(operative time,incision length,total blood loss[intraoperative and postoperative],time to first ambulation,incision healing status,length of hospital stay,visual analog scale[VAS]pain scores,the American Knee Society scores[KSS],range of motion[ROM]of the knee joint,and femorotibial angle[FTA]).Results:The follow-up period was 12 to 16 months,with a mean of(13.1±2.8)months.There were no intraoperative neurovascular injuries or serious postoperative complications such as infections or deep vein thrombosis in either group.The kinematic group had a significantly shorter time to first ambulation and length of hospital stay compared to the mechanical group(P<0.05).There were no significant differences between the two groups in operative time,incision length,total blood loss,or incision healing status(P>0.05).Preoperatively,there were no statistically significant differences between the two groups in VAS scores,KSS scores,knee joint flexion-extension ROM,or FTA(P>0.05).There were no significant differences between the two groups in preoperative VAS scores,KSS scores,knee joint flexion-extension ROM,or FTA(P>0.05).One month postoperatively,the kinematic group had lower VAS scores,higher KSS scores,greater knee joint flexion-extension ROM,and smaller FTA compare to the mechanical group(all P<0.05).At six-month and the final follow-up,the kinematic group had a significantly smaller FTA compared to the mechanical group(P<0.05),with no statistically differences in VAS scores,KSS scores,or knee joint flexion-extension ROM(P>0.05).Conclusions:The appliciation of 3D printed individualized osteotomy guides combined with kinematic alignment in TKA for patients with end-stage knee osteoarthritis is clinically effective,demonstrating high precision and safety.