3D打印个性化截骨导板辅助全膝关节置换术治疗膝骨关节炎合并关节外畸形
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摘要
目的评估基于3D打印个性化截骨导板辅助全膝关节置换术治疗膝骨关节炎合并关节外畸形患者的短期疗效以及截骨数据的精确性。方法回顾性研究2016至2018年间在我院就诊的9例(10膝)膝骨关节炎并有明显的关节外畸形的患者,应用3D打印个性化截骨导板辅助全膝关节置换术,比较手术前后的影像学参数和临床结果。结果截至末次随访时,X线片示假体位置良好;下肢力线偏移(1.80±0.60)°,与术前(13.11±3.10)°比较差异有统计学意义;HSS临床评分为((85.33±2.69)分,与术前(47.79±13.73)分比较差异有统计学意义;膝关节活动度为(90.00±5.57)°,与术前(69.56±7.09)°比较差异有统计学意义;股骨远端内侧髁术前模拟截骨(4.48±1.50)mm,实际操作截骨(4.39±1.51)mm;远端外侧髁术前模拟截骨(7.44±2.36)mm,实际操作截骨(7.32±2.35)mm,差异无统计学意义。结论 3D打印个性化截骨导板在伴关节外畸形的人工膝关节置换术中可以提高截骨的精准性,帮助获得良好的假体定位,并具有良好的早期临床疗效。本研究证明这种特定于患者的个性化截骨辅助技术的有效性,并能支持手术精确性的可重复改进。同时这项新技术的长期效果仍有待于进一步的后续观察证实。
Objective To evaluate the short-term efficacy and the accuracy of osteotomy data based on the 3 D printed patientspecific instruments assisted total knee arthroplasty for the treatment of patients with knee osteoarthritis combined with extra-articular deformity. Methods A retrospective study was conducted on 9 cases(10 knees) of knee osteoarthritis with obvious external joint deformity treated in our hospital between 2016 and 2018. Results At the end of the follow-up, X-ray showed good position of the prosthesis. Lower limb power shift(1.80±0.60) °, compared with the preoperative(13.11±3.10) °difference was statistically significant; The HSS clinical score was(85.33±2.69), which was statistically significant compared with the preoperative score(47.79±13.73). For knee joint mobility(90.00±5.57) °, compared with the preoperative(69.56±7.09) ° difference was statistically significant; The simulated osteotomy of the distal medial condyle of the femur(4.48±1.50) mm, and the actual osteotomy(4.39±1.51) mm; The simulated osteotomy of distal lateral condyle(7.44±2.36) mm and the actual osteotomy(7.32±2.35) mm were not statistically significant. Conclusion 3 D printedpatient-specific instruments can improve the accuracy of osteotomy in artificial knee joint replacement with external joint deformity, help to obtain good prosthesis localization and have good early clinical effect. This study demonstrates the effectiveness of this patient-specific individualized osteotomy assistant technique and supports the repeatable improvement of surgical accuracy. At the same time, the long-term effect of the new technology remains to be confirmed by further observation.
Objective To evaluate the short-term efficacy and the accuracy of osteotomy data based on the 3 D printed patientspecific instruments assisted total knee arthroplasty for the treatment of patients with knee osteoarthritis combined with extra-articular deformity. Methods A retrospective study was conducted on 9 cases(10 knees) of knee osteoarthritis with obvious external joint deformity treated in our hospital between 2016 and 2018. Results At the end of the follow-up, X-ray showed good position of the prosthesis. Lower limb power shift(1.80±0.60) °, compared with the preoperative(13.11±3.10) °difference was statistically significant; The HSS clinical score was(85.33±2.69), which was statistically significant compared with the preoperative score(47.79±13.73). For knee joint mobility(90.00±5.57) °, compared with the preoperative(69.56±7.09) ° difference was statistically significant; The simulated osteotomy of the distal medial condyle of the femur(4.48±1.50) mm, and the actual osteotomy(4.39±1.51) mm; The simulated osteotomy of distal lateral condyle(7.44±2.36) mm and the actual osteotomy(7.32±2.35) mm were not statistically significant. Conclusion 3 D printedpatient-specific instruments can improve the accuracy of osteotomy in artificial knee joint replacement with external joint deformity, help to obtain good prosthesis localization and have good early clinical effect. This study demonstrates the effectiveness of this patient-specific individualized osteotomy assistant technique and supports the repeatable improvement of surgical accuracy. At the same time, the long-term effect of the new technology remains to be confirmed by further observation.
引文
[1]牛鸣,马飞,马菊蓉,等.基于3D打印的个性化截骨技术与传统方式行全膝关节表面置换的临床对比[J].南方医科大学学报,2017(11):1467-1475.
[2]Lee SH,Song EK,Seon JK,et al.A Comparative Study Between PatientSpecific Instrumentation and Conventional Technique in TKA[J].Orthopedics,2016,39(3 Suppl):S83-7.
[3]Ferrara F,Cipriani A,Magarelli N,et al.Implant positioning in TKA:comparison between conventional and patient-specific instrumentation[J].Orthopedics,2015,38(4):e271-80.
[4]童培建.复杂全膝关节置换术的手术策略[J].中医正骨,2013(01):3-7.
[5]林丽琼,冯尔宥,肖莉莉,等.3D打印截骨模具在伴关节外畸形的人工膝关节置换术中的应用[J].中华损伤与修复杂志(电子版),2016(04):285-287.
[6]Thienpont E,Paternostre F,Pietsch M,et al.Total knee arthroplasty with patient-specific instruments improves function and restores limb alignment in patients with extra-articular deformity[J].The Knee,2013,20(6):407-411.
[7]孙振国,朱佳俊,崔岩,等.基于3D打印技术行全膝关节置换治疗内翻畸形膝骨性关节炎[J].中国组织工程研究,2017(15):2395-2399.
[8]叶一林,柴卫兵,卢宏章,等.伴有关节外畸形的膝骨关节炎行全膝关节置换术的治疗体会[J].中国骨与关节外科,2014(05):399-403.
[9]Chou WY,Ko JY,Wang CJ,et al.Navigation-assisted total knee arthroplasty for a knee with malunion of the distal femur[J].J Arthroplasty,2008,23:1239.
[10]刘振中,时剑辉,王岩,等.3D打印截骨模具辅助全膝关节表面置换术的临床效果[J].黑龙江医药,2016(04):718-720.
[11]汪锡龙,尚希福,李国远,等.个体化股骨远端外翻角度截骨技术在初次人工全膝关节置换术中的应用[J].中国修复重建外科杂志,2015,29(1):27-30.
[12]Hamada D,Egawa H,Goto T,et al.Navigation-Assisted Total Knee Arthroplasty for Osteoarthritis with Extra-Articular Femoral Deformity and/or Retained Hardware[J].Case reports in orthopedics,2013,2013:174384.
[13]Paredes-Carnero X,Escobar J,Galdo JM.Total knee arthroplasty for treatment of osteoarthritis associated with extra-articular deformity[J].Clin Orthop Trauma,2018,9:125-132.
[14]张伟,金玉林.3D打印技术在全膝关节置换术中临床应用[J].中国医学创新,2014(24):130-134.
[15]Wang JW,Wang CJ.Total knee arthroplasty for arthritis of the knee with extra-articular deformity[J].J Bone Joint Surg Am,2002,84:1769-74.
[16]Mullaji A,Shetty GM.Computer-assisted total knee arthroplasty for arthritis with extra-articular deformity[J].J Arthroplasty,2009,24:1164-9.
[17]许志庆,王武炼,庄至坤,等.3D打印技术辅助人工全膝关节置换术治疗合并关节外畸形的膝骨关节炎[J].中国修复重建外科杂志,2017(08):913-917.
[18]K?ster G.Total and uni-compartmental knee replacement Patient-specific Instrumentation[J].Der Orthopa?de,2016,45(4):302-313.
[19]Kim KI,Ramteke AA,Bae DK.Navigation-assisted minimal invasive total knee arthroplasty in patients with extra-articular fémoral deformity[J].JArthroplasty,2010,25:658.
[2]Lee SH,Song EK,Seon JK,et al.A Comparative Study Between PatientSpecific Instrumentation and Conventional Technique in TKA[J].Orthopedics,2016,39(3 Suppl):S83-7.
[3]Ferrara F,Cipriani A,Magarelli N,et al.Implant positioning in TKA:comparison between conventional and patient-specific instrumentation[J].Orthopedics,2015,38(4):e271-80.
[4]童培建.复杂全膝关节置换术的手术策略[J].中医正骨,2013(01):3-7.
[5]林丽琼,冯尔宥,肖莉莉,等.3D打印截骨模具在伴关节外畸形的人工膝关节置换术中的应用[J].中华损伤与修复杂志(电子版),2016(04):285-287.
[6]Thienpont E,Paternostre F,Pietsch M,et al.Total knee arthroplasty with patient-specific instruments improves function and restores limb alignment in patients with extra-articular deformity[J].The Knee,2013,20(6):407-411.
[7]孙振国,朱佳俊,崔岩,等.基于3D打印技术行全膝关节置换治疗内翻畸形膝骨性关节炎[J].中国组织工程研究,2017(15):2395-2399.
[8]叶一林,柴卫兵,卢宏章,等.伴有关节外畸形的膝骨关节炎行全膝关节置换术的治疗体会[J].中国骨与关节外科,2014(05):399-403.
[9]Chou WY,Ko JY,Wang CJ,et al.Navigation-assisted total knee arthroplasty for a knee with malunion of the distal femur[J].J Arthroplasty,2008,23:1239.
[10]刘振中,时剑辉,王岩,等.3D打印截骨模具辅助全膝关节表面置换术的临床效果[J].黑龙江医药,2016(04):718-720.
[11]汪锡龙,尚希福,李国远,等.个体化股骨远端外翻角度截骨技术在初次人工全膝关节置换术中的应用[J].中国修复重建外科杂志,2015,29(1):27-30.
[12]Hamada D,Egawa H,Goto T,et al.Navigation-Assisted Total Knee Arthroplasty for Osteoarthritis with Extra-Articular Femoral Deformity and/or Retained Hardware[J].Case reports in orthopedics,2013,2013:174384.
[13]Paredes-Carnero X,Escobar J,Galdo JM.Total knee arthroplasty for treatment of osteoarthritis associated with extra-articular deformity[J].Clin Orthop Trauma,2018,9:125-132.
[14]张伟,金玉林.3D打印技术在全膝关节置换术中临床应用[J].中国医学创新,2014(24):130-134.
[15]Wang JW,Wang CJ.Total knee arthroplasty for arthritis of the knee with extra-articular deformity[J].J Bone Joint Surg Am,2002,84:1769-74.
[16]Mullaji A,Shetty GM.Computer-assisted total knee arthroplasty for arthritis with extra-articular deformity[J].J Arthroplasty,2009,24:1164-9.
[17]许志庆,王武炼,庄至坤,等.3D打印技术辅助人工全膝关节置换术治疗合并关节外畸形的膝骨关节炎[J].中国修复重建外科杂志,2017(08):913-917.
[18]K?ster G.Total and uni-compartmental knee replacement Patient-specific Instrumentation[J].Der Orthopa?de,2016,45(4):302-313.
[19]Kim KI,Ramteke AA,Bae DK.Navigation-assisted minimal invasive total knee arthroplasty in patients with extra-articular fémoral deformity[J].JArthroplasty,2010,25:658.