3D打印截骨导板在内翻型踝关节炎踝上截骨术中的应用效果观察

Application effect of 3D printed osteotomy guide plate in supramalleolar on varus ankle arthritis

目的探讨3D打印截骨导板在踝上截骨术治疗内翻型踝关节炎中的临床效果。方法回顾性队列研究。纳入2019年1月—2022年6月徐州仁慈医院采用踝上截骨术治疗的19例内翻型踝关节炎患者的临床和影像学资料。患者年龄36~63岁, 其中, 男12例、女7例, 左足10例、右足9例, TakakuraⅡ期7例、Ⅲa期9例、Ⅲb期3例。患者根据不同手术方式分组:观察组8例, 均采用3D打印截骨导板截骨;对照组11例, 均采用传统踝上截骨治疗。观察指标:(1)比较2组患者的手术时间、术中透视次数、出血量及骨愈合时间。(2)比较2组术前及术后末次随访时的疼痛视觉模拟评分法(VAS)评分、踝关节功能评价指标美国足踝外科协会(AOFAS)踝-后足评分, 以及影像学测量指标后胫骨前侧关节面(TAS)角、胫骨侧面关节面(TLS)角及距骨倾斜(TT)角。结果观察组与对照组性别、年龄、侧别、Takakura分期等基线资料比较, 差异均无统计学意义(P值均>0.05)。19例患者均顺利完成手术, 术后均获随访, 随访时间16~24(19.3±3.1)个月。(1)观察组手术时间为96(92, 103)min、较对照组的127(125, 132)min更短, 透视次数为2(2, 3)次、较对照组的4(4, 5)次更少, 差异均有统计学意义(Z=3.60、3.45, P值均<0.001)。观察组术中出血量为30(21, 43)mL, 对照组为60(50, 90)mL, 差异有统计学意义(Z=3.38, P<0.001);观察组骨愈合时间为13(12, 13)周, 对照组为13(12, 13)周, 差异无统计学意义(Z=1.02, P=0.351)。(2)组内比较:观察组末次随访AOFAS评分为89.5(88.0, 91.5)分、VAS评分为1.0(0.5, 1.5)分, TAS角为 90.9°(89.9°, 91.8°)、TT 角为0.1°(0.0°, 0.4°), 均较术前的60.5(57.5, 65.5)分、4.0(3.5, 5.5)分、83.6°(83.1°, 84.2°)、1.9°(1.3°, 2.6°)改善明显, 差异均有统计学意义(t=30.33、5.40、25.43、6.19, P值均<0.05);对照组末次随访AOFAS评分为88.0(87.0, 90.0)分、VAS评分为1.0(1.0, 2.0)分、TAS角为 90.5°(89.6°, 91.6°)、TT为 0.0°(0.0°, 0.5°), 均较术前的56.0(53.0, 65.0)分、4.0(4.0, 5.0)分、83.3°(81.4°, 84.5°)、2.3°(1.2°, 2.7°)改善明显, 差异均有统计学意义(t=16.54、7.87、39.05、9.15, P值均<0.001);2组末次随访TLS角与术前比较差异均无统计学意义(P值均>0.05)。组间比较:2组患者AOFAS评分、VAS评分, 以及TAS角、TT 角、TLS角, 术前及术后末次随访差异均无统计学意义(P值均>0.05)。结论 3D打印截骨导板截骨术治疗踝关节炎安全有效, 具有操作简单, 导板限深、截骨精准的特点, 疗效与传统踝上截骨治疗踝关节炎相当, 并且术中手术时间更短、透视次数更少。

Objective This study aimed to explore the clinical effect of 3D printed osteotomy guide plate in supramalleolar osteotomy on varus ankle arthritis.Methods This retrospective cohort study was conducted on the clinical and imaging data of 19 patients with varus ankle arthritis treated by supramalleolar osteotomy from January 2019 to June 2022 in Xuzhou Renci Hospital.The patients included 12 males and 7 females,aged 36-63 years,10 left feet and 9 right feet,7 Takakura stageⅡ,9Ⅲa,and 3Ⅲb.Patients were divided into two groups according to different surgical methods:observation group(8 cases of osteotomy with 3D printed osteotomy guide)and control group(11 cases treated with traditional supramalleolar osteotomy).(1)Operation time,intraoperative fluoroscopy times,hemorrhagic volumes and bone healing times were compared between the two groups.(2)The pain visual analogue scale(VAS)score,the ankle function evaluation index of American Association of Foot and Ankle Surgery(AOFAS)ankle-posterior foot score,and the imaging measurements of posterior anterior tibial articular surface(TAS)angle,tibial lateral articular surface(TLS)angle,and talus tilt(TT)Angle were compared between the two groups before and after the last follow-up.Results Sex,age,and Takakura stage were not significantly different between the observation and control groups(all P values>0.05).(1)All patients completed the operation and were followed up for 16-24(19.3±3.1)months.The operation time in the observation group was 96(92,103)min,which was shorter than that in the control group(127[125,132]min),and the fluoroscopy time was 2(2,3)times,which was lower than that in the control group(4[4,5]times).The differences were statistically significant(Z=3.60,3.45,all P values<0.001).The intra-operative hemorrhagic volumes were 30(21,43)and 60(50,90)mL in the observation and control groups,respectively,and the difference was statistically significant(Z=3.38,P<0.001).The bone healing times were 13(12,13)weeks and 13(12,13)weeks in the observation and control groups,respectively,and the difference was not statistically significant(Z=1.02,P=0.351).(2)For intra-group comparison,the AOFAS and VAS scores of the observation group at the last follow-up were 89.5(88.0,91.5)and 1(0.5,1.5)points,the TAS angle was 90.9°(89.9°,91.8°),and the TT angle was 0.1°(0°,0.4°);all of these values were lower than the preoperative scores of 60.5(57.5,65.5)points,4.0(3.5,5.5)points and angles of 83.6°(83.1°,84.2°)and 1.9°(1.3°,2.6°),respectively;the differences were statistically significant(t=30.33,5.40,25.43,6.19,all P values<0.05).At the last follow-up,the AOFAS score of the control group was 88.0(87.0,90.0)points,the VAS score was 1.0(1.0,2.0)points,the TAS angle was 90.5°(89.6°,91.6°),and the TT angle was 0.0°(0.0°,0.5°),which were all lower than the preoperative values of 56.0(53.0,65.0)points,4.0(4.0,5.0)points,83.3°(81.4°.84.5°),and 2.3°(1.2°,2.7°);the differences were statistically significant(t=16.54,7.87,39.05,9.15,all P values<0.001).No significant difference in the TLS angle was found between the two groups at the last follow-up and before surgery(all P values>0.05).For comparison between groups,no significant differences in AOFAS score,VAS score,TAS angle,TT angle,and TLS angle were found between the two groups before and at the last follow-up after surgery(all P values>0.05).Conclusion Hence,3D printing osteotomy with guide plate is safe and effective in the treatment of ankle arthritis.It has the characteristics of simple operation,deep limit of guide plate,and precise osteotomy.It also has the same efficacy as traditional supramalleolar osteotomy for the treatment of ankle arthritis but has shorter operative time and fewer number of fluoroscopy.