3D打印截骨导板在膝骨关节炎患者全膝关节置换术中的应用

Clinical application of 3D-printed osteotomy guides total knee arthroplasty in patients with knee osteoarthritis

目的:探讨膝骨关节炎(KOA)患者采用3D打印截骨导板进行全膝关节置换术(TKA)术中截骨操作的效果。方法:选择2022年1月至2023年4月张家口市第一医院收治的110例KOA患者进行研究,以随机数字表法分为两组各55例,传统手术组采用传统手术器械进行术中截骨;3D打印组运用3D打印截骨导板进行术中截骨。比较两组患者手术前后的疼痛视觉模拟评分(VAS)、围手术期指标(手术时间、术中出血量、术后24 h引流量、住院时间)、术后并发症发生情况、膝关节运动学指标及患者满意度。结果:两组患者术前VAS评分比较,差异无统计学意义(P>0.05),3D打印组患者术后1周的VAS评分低于传统手术组(P<0.05)。3D打印组患者的手术时间、术中出血量、术后24 h引流量均低于传统手术组,差异均有统计学意义(P均<0.05);两组患者的住院时间比较,差异无统计学意义(P>0.05)。术后1、3个月,3D打印组患者的内外翻角、内外旋角均低于传统手术组、屈伸角高于传统手术组,差异均有统计学意义(P均<0.05)。术后1年随访期间,3D打印组患者术后并发症总发生率低于传统手术组,差异有统计意义(P<0.05)。3D打印组患者术后1年患者满意度高于传统手术组,差异有统计学意义(P<0.05)。结论:KOA患者采用3D打印截骨导板进行TKA术中截骨操作,不仅可以缩短手术时间、有效缓解患者疼痛,还能降低术后并发症发生率,促进膝关节功能恢复,有效改善患者预后。

Objective:To evaluate the effectiveness of 3D-printed osteotomy guides in total knee arthroplasty(TKA)for patients with knee osteoarthritis(KOA).Methods:This study was conducted on 110 KOA patients treated at the First Hospital of Zhangjiakou City from January 2022 to April 2023.The patients were randomly divided into two groups:the traditional surgery group(55 patients),in which conventional surgical instruments were used for osteotomy,and the 3D printing group(55 patients),in which 3D-printed osteotomy guides were used.Pre-and postoperative VAS scores,perioperative indicators(operation duration,intraoperative blood loss,24-hour postoperative drainage volume,length of hospital stay),postoperative complications,knee kinematics,and patient satisfaction were compared between the two groups.Results:There was no significant difference in the preoperative VAS score between the two groups(P>0.05).At one week after surgery,the VAS score was significantly lower in the 3D printing group than in the traditional surgery group(P<0.05).Compared with the traditional surgery group,the 3D printing group had significantly shorter operation duration,less intraoperative blood loss,and lower postoperative 24-hour drainage volumes(all P<0.05).There was no statistically significant difference in the length of hospital stay between the two groups(P>0.05).During the 3-month postoperative follow-up,the overall incidence of complications was significantly lower in the 3D printing group(P<0.05).At 1 and 3 months post-surgery,the 3D printing group presented significantly lower varus-valgus angles and internal-external rotation angles and significantly greater flexionextension angles than the traditional surgery group did(all P<0.05).Patient satisfaction at one year postoperatively was significantly greater in the 3D printing group(P<0.05).Conclusions:Using 3D-printed osteotomy guides in TKA for KOA patients can shorten the operation duration,effectively relieve pain,reduce the incidence of postoperative complications,enhance knee function recovery,and improve patient outcomes.