| 明朝畅,冯家威,裴鸿鑫,等.3D打印个体化导板辅助下固定平台单髁置换术治疗膝骨关节炎的早期临床疗效.骨科,2025,16(1): 14-19. |
| 3D打印个体化导板辅助下固定平台单髁置换术治疗膝骨关节炎的早期临床疗效 |
| Early clinical efficacy of fixed-platform unicompartmental knee arthroplasty assisted by 3D-printed patient-specific instrumentation in treating knee osteoarthritis |
| 投稿时间：2024-08-28 |
| DOI：10.3969/j.issn.1674-8573.2025.01.003 |
| 中文关键词: 膝骨关节炎 个性化导板 固定平台单髁 关节成形术，置换，膝 假体安装 |
| 英文关键词: Knee osteoarthritis PSI Fixed-platform unicompartmental Arthroplasty, replacement, knee Prothesis fitting |
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| 中文摘要: |
| 目的 探讨3D打印个体化导板（patient-specific instrumentation，PSI）辅助下膝关节固定平台单髁置换术（UKA）治疗膝骨关节炎的早期临床效果。方法 回顾性研究2023年5月至2023年10月滑县骨科医院收治的20例膝关节内侧间室骨关节炎病人，年龄为（65.5±11.5）岁（55~78岁）；男8例，女12例。所有病人Kellgren-Lawrence分级均为Ⅳ级。采用人工智能结合3D打印技术辅助UKA手术，术前规划截骨位置、截骨量、假体类型及摆放位置，术中利用PSI进行精准截骨。记录手术时间、术后首次下地时间、住院时长、手术前后髋-膝-踝（hip-knee-ankle，HKA）角变化、胫骨假体力线偏差，并比较术前和术后3个月美国特种外科医院（Hospital for Special Surgery，HSS）膝关节功能评分。结果 所有病人均获得随访，平均随访时间8个月。手术切口长度（7.76±1.42） cm，手术时间（58.50±3.68） min，住院时长（9.5±1.2） d，下地时间（7.34±1.56） h。术后1周及10个月X线复查显示股骨和胫骨截骨满意，无输血和并发症。术前HKA角为8.04°±0.71°，术后降至2.87°±0.51°；术前HSS评分中位数为76.75（70.35，78.25）分，术后3个月升至90.15（88.80，92.95）分，差异均有统计学意义（P＜0.05）。20例中1例胫骨平台前内侧未完全贴附，术中手动纠正。其余病人截骨量与术前规划一致，假体活动轨迹良好，膝关节屈伸间隙一致，切口愈合良好，假体位置满意。结论 3D打印PSI辅助下的固定平台UKA具有精准截骨、操作方便、易于学习的优点，能够显著改善术后下肢力线和膝关节功能，早期临床效果良好。 |
| 英文摘要: |
| Objective To explore the early clinical outcomes of fixed-platform unicompartmental knee arthroplasty (UKA) using patient-specific instrumentation (PSI) with the assistance of 3D printing in treating knee osteoarthritis. Methods This study included 20 patients with medial compartment knee osteoarthritis in Huaxian Orthopedic Hospital from May 2023 to October 2023, aged (65.5±11.5) years (55-78 years). There were 8 males and 12 females. All patients had a Kellgren-Lawrence classification of grade Ⅳ. UKA, assisted by AI and 3D printing, involved preoperative planning for osteotomy site, volume, prosthesis type, and placement. PSI was used to ensure precise cutting guide attachment during surgery. The operation time, the time to ambulation, length of hospital stay, changes in hip-knee-ankle (HKA) angle before and after surgery, tibial prosthesis alignment deviation, and Hospital for Special Surgery (HSS) knee function scores before and 3 months after surgery were recorded. Results All patients were followed up for an average duration of 8 months. The incision length was (7.76±1.42) cm, the surgery time was (58.50±3.68) min, the length of hospital stay was (9.5±1.2) d and the time to ambulation was (7.34±1.56) h. X-rays at 1st week and 10th month postoperatively showed satisfactory femoral and tibial osteotomies, with no blood transfusion or complications. The preoperative HKA angle was 8.04°±0.71°, decreased to 2.87°±0.51° postoperatively, and the preoperative HSS score was 76.75 (70.35, 78.25), which increased to 90.15 (88.80, 92.95) at 3rd month postoperatively, showing a statistically significant difference (P＜0.05). In 1 case, the anterior medial tibial platform did not fully attach and was manually corrected intraoperatively. The osteotomy volume in the other patients matched the design, with good prosthetic motion trajectory, consistent knee flexion-extension gaps, good incision healing, and satisfactory prosthetic positioning. Conclusion UKA assisted by PSI with 3D printing technology offers advantages such as precise osteotomy, ease of operation, and ease of learning. It can significantly improve postoperative lower limb alignment and knee function with favorable early clinical outcomes. |
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