3D打印导板改善人工全膝关节置换术中股骨旋转对线及髌骨轨迹的疗效研究

目的探讨人工全膝关节置换术(total knee arthroplasty,TKA)中采用3D打印导板辅助定位改善股骨旋转对线及髌骨轨迹的效果。方法选择2018年1月-10月60例(60膝)接受TKA治疗且符合选择标准的膝关节晚期骨关节炎患者作为研究对象,按照随机数字表法分为两组,每组30例。导板组行3D打印导板辅助下TKA,对照组行传统TKA。两组患者性别、年龄、病程、侧别以及术前髋-膝-踝角(hip-knee-ankle angle,HKA)、股骨后髁角(posterior condylar angle,PCA)、髌骨横轴-股骨通髁线角(patella transverse axis-femoral transepicondylar axis angle,PFA)、美国特种医院(HSS)评分、美国膝关节协会(AKS)评分比较,差异均无统计学意义(P>0.05)。结果患者术后切口均Ⅰ期愈合,无手术相关并发症发生。两组患者均获随访,随访时间10~12个月,平均11个月。两组术后6个月HSS评分及AKS评分均较术前明显提高(P<0.05),组间比较差异无统计学意义(P>0.05)。术后X线片复查示假体位置良好,随访期间无假体松动、下沉等发生。两组术后10个月HKA、PCA、PFA均较术前明显改善(P<0.05);两组HKA比较差异无统计学意义(t=1.031,P=0.307);导板组PCA、PFA均明显小于对照组(P<0.05)。结论3D打印导板辅助TKA不仅能矫正膝关节畸形及减轻疼痛症状,还能达到股骨旋转对线准确、恢复良好髌骨轨迹的目标。

Effect of three-dimensional printing guide plate on improving femoral rotational alignment and patellar tracking in total knee arthroplasty

Objective To investigate the effect of three-dimensional(3 D)printing guide plate on improving femoral rotational alignment and patellar tracking in total knee arthroplasty(TKA).Methods Between January 2018 and October 2018,60 patients(60 knees)with advanced knee osteoarthritis who received TKA and met the selection criteria were selected as the study subjects.Patients were randomly divided into two groups according to the random number table method,with 30 patients in each group.The TKA was done with the help of 3 D printing guide plate in the guide group and following traditional procedure in the control group.There was no significant difference in gender,age,disease duration,side,and preoperative hip-knee-ankle angle(HKA),posterior condylar angle(PCA),patella transverse axisfemoral transepicondylar axis angle(PFA),Hospital for Special Surgery(HSS)score,and American Knee Society(AKS)score(P>0.05).Results All incisions healed by first intention and no complications related to the operation occurred.All patients were followed up 10-12 months,with an average of 11 months.HSS score and AKS score of the two groups at6 months after operation were significantly higher than those before operation(P<0.05),but there was no significant difference between the two groups(P>0.05).Postoperative X-ray films showed that the prosthesis was in good position,and no prosthesis loosening or sinking occurred during follow-up.HKA,PCA,and PFA significantly improved in the two groups at 10 months after operation compared with those before operation(P<0.05).There was no significant difference in HKA at 10 months between the two groups(t=1.031,P=0.307).PCA and PFA in the guide group were smaller than those in the control group(P<0.05).Conclusion Application of 3 D printing guide plate in TKA can not only correct the deformity of the knee joint and alleviate the pain symptoms,but also achieve the goal of the accurate femoral rotation alignment and good patellar tracking.