| 许志庆,庄至坤,林行会,等.3D打印个性化截骨导板辅助开放楔形胫骨高位截骨术治疗膝内翻畸形骨关节炎的临床疗效.骨科,2025,16(4): 315-320. |
| 3D打印个性化截骨导板辅助开放楔形胫骨高位截骨术治疗膝内翻畸形骨关节炎的临床疗效 |
| Clinical efficacy of 3D-printed patient specific instrument assisted open wedge high tibial osteotomy in the treatment of varus knee osteoarthritis |
| 投稿时间：2024-12-02 |
| DOI：DOI：10.3969/j.issn.1674-8573.2025.04.005 |
| 中文关键词: 3D打印 个性化截骨导板 胫骨高位开放楔形截骨术 膝内翻畸形骨关节炎 |
| 英文关键词: 3D-printed Patient specific instrument Open wedge high tibial osteotomy Varus knee osteoarthritis |
| 基金项目:福建省卫健委科技计划项目青年科研课题（2022QNB007）；泉州市级科技计划项目（2023NS090） |
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| 中文摘要: |
| 目的 探讨3D打印个性化截骨导板（patient specific instrumentation，PSI）辅助开放楔形胫骨高位截骨术（open wedge high tibial osteotomy，OWHTO）治疗膝内翻畸形骨关节炎的临床疗效。方法 回顾性分析2020年3月至2024年3月我院36例（36膝）膝内翻畸形骨关节炎行OWHTO病人的临床资料，其中3D打印PSI行OWHTO 15例（PSI组，15膝）和传统工具行OWHTO 21例（传统工具组，21膝），记录并比较两组术中出血量、手术时间、术中“C”型臂X线机透视次数、术后实际胫骨近端内侧角（medial proximal tibial angle，MPTA）与术前规划差值、末次随访美国特种外科医院（Hospital for Special Surgery，HSS）膝关节功能评分及膝关节内侧间室Kellgren-Lawrence（K-L）分级、术后实际胫骨平台后倾角（posterior tibial slope，PTS）与术前差值、负重力线比值（weight bearing line ratio，WBLR）在术前规划±10%内的病人比例和并发症。结果 PSI组术中出血量、手术时间、透视次数均优于传统工具组，差异有统计学意义（P＜0.05）。病人均获得随访，随访时间为6~48个月。两组均未发生深静脉血栓、切口愈合不良、感染、截骨端延迟愈合及不愈合。PSI组术后实际MPTA与术前规划差值、末次随访HSS评分及K-L分级与传统工具组比较，差异无统计学意义（P＞0.05）。PSI组术后实际PTS与术前差值、WBLR在术前规划±10%内的病人比例优于传统工具组，差异有统计学意义（P＜0.05）。结论 3D打印PSI辅助OWHTO治疗膝内翻畸形骨关节炎可以减少术中透视次数，缩短手术时间，减少术中出血，术中截骨操作更加精准，更好地维持PTS，术后力线恢复更佳。 |
| 英文摘要: |
| Objective To investigate the clinical efficacy of 3D-printed patient specific instrument (PSI) assisted open wedge high tibial osteotomy (OWHTO) in the treatment of varus knee osteoarthritis. Methods From March 2020 to March 2024, 36 patients undergoing OWHTO were reviewed, including 15 patients in the 3D-printed PSI group and 21 patients in conventional instrument group. Intraoperative blood loss, surgical time, frequency of fluoroscopy, difference between postoperative medial proximal tibial angle (MPTA) and preoperative planning, Hospital for Special Surgery (HSS) scores, Kellgren-Lawrence (K-L) scale of medial compartment of knee at the last follow-up, difference between postoperative posterior tibial slope (PTS) and preoperative planning, proportion of patients with difference at 10% between postoperative weight bearing line ratio (WBLR) and preoperative planning and complications were compared between the two groups. Results PSI group demonstrated less intraoperative blood loss, shorter surgical time, and lower frequency of fluoroscopy than the conventional instrument group, with statistically significant differences (P＜0.05). All patients were followed up from 6 to 48 months. There were no complications. The difference between postoperative MPTA and preoperative planning, HSS scores, K-L scale of medial compartment of knee at the last follow-up were not statistically significant between the two groups (P＞0.05). The PSI group demonstrated more significant difference between postoperative PTS and preoperative planning, higher proportion of patients with difference at 10% between postoperative WBLR and preoperative planning than the conventional instrument group, with statistically significant differences (P＜0.05). Conclusion 3D-printed PSI assisted OWHTO has many obvious advantages, such as less intraoperative blood loss, shorter surgical time, and lower frequency of fluoroscopy, higher accuracy of the osteotomy, more accurate alignment of lower extremity correction. |
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