目的 评价模拟手术结合3D打印个性化导航模板（patient-specific instrumentation，PSI）应用于内侧开放楔形胫骨高位截骨术（high tibial osteotomy，HTO）其保膝治疗的精准性和安全性。 方法 回顾性分析2019年5月~2021年5月应用模拟手术结合3D打印PSI辅助内侧开放楔形HTO治疗的膝骨关节炎患者23例，其中男性2例，女性21例；年龄49~83岁，平均58.9岁；病程1~30年，平均6.3年。术前和术后测量胫骨近端内侧角（medialproximal tibial angle，MPTA）、髋-膝-踝角（hip-knee-ankle angle，HKA）、下肢负重线比率（weight bearing lineratio，WBL）、胫骨平台后倾角（posterior tibialslope angle，PTSA）和关节线会聚角（joint line convergence angle，JLCA）。记录患者术前和末次随访的VAS疼痛评分与AKS膝关节功能评分。 结果 所有患者获得随访，随访时间为7~19个月，平均11.8个月。术后测量结果：WBL（57.52±3.99）%，MPTA（90.77±0.68）°，HKA（182.84±1.58）°，JCLA（0.17±0.36）°，以上指标均显著优于术前（P<0.05）；PTSA（8.22±1.17）°，比术前略有改善（P>0.05）。术后各影像学指标接近设计目标值（P>0.05），下肢力线矫正满意。末次随访时，截骨处均已愈合，VAS、AKS均较术前显著改善（P<0.05）。 结论 模拟手术结合3D打印PSI辅助内侧开放楔形HTO治疗膝骨关节炎，可获得满意矫正效果，精准度较高，疗效可靠。
Abstract
Objective To investigate the accuracy and safety of simulated surgery combined with 3D printing patient-specific instrumentation (PSI) assisted medial open wedge high tibial osteotomy (HTO) in knee osteoarthritis. Methods The clinical data of 23 patients with knee osteoarthritis who were treated with simulated surgery combined with 3D printing PSI assisted medial open-wedge HTO between May 2019 and May 2021 were retrospectively analyzed. There were 2 males and 21 females, with an average age of 58.9 years (ranged 49-83 years). The disease duration ranged from 1 to 30 years, with an average of 6.3 years. Postoperatively, the weight bearing lineratio(WBL), medial proximal tibial angle (MPTA), hip-knee-ankle angle (PTSA), knee-ankle angle (HKA) and joint line convergence angle (JLCA) were measured and compared with the preoperative values, and the postoperative WBL, HKA, MPTA and actual correction angle of the lower limbs were compared with the preoperative design target values. At the final follow-up, the knee pain and function were assessed by VAS and AKS. Results All the patients were followed up for 7-19 months, with an average of 11.8 months. The postoperative WBL (57.52±3.99) %, MPTA (90.77±0.68)°, HKA (182.84±1.58)°, and JCLA (0.17±0.36)°were significantly improved compared with the preoperative values (P<0.05). There was no significant difference between preoperative and postoperative PTSA (P>0.05). The postoperative WBL, MPTA, HKA and actual correction angle of the lower limbs were slightly lower than the preoperative design target values, but the differences were not significant(P>0.05). At the final follow-up, the VAS scores were (0.78±0.52), which were significantly lower than the preoperative VAS scores (P<0.05). The AKS scores were (88.52±2.98), which were significantly higher than the preoperative AKS scores (P<0.05). Conclusions Simulated surgery combined with 3D printing PSI surgery assisted HTO is an effective method in knee osteoarthritis, which can achieve satisfactory clinical effects.
关键词
膝骨关节炎； /
/
3D打印； /
/
胫骨高位截骨术； /
/
模拟手术； /
/
个性化导航模板
Key words
Knee osteoarthritis; /
/
3D printing; /
/
High tibial osteotomy; /
/
Simulated surgery; /
/
Patient-specific instrumentation
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Hunter DJ, Bierma Zeinstra S. Osteoarthritis[J]. Lancet, 2019, 393: 1745-1759. DOI: 10.1016/S0140-6736(19)30417-9.
[2] 王飞, 陈百成, 高石军, 等. 内侧撑开和外侧闭合胫骨高位截骨术治疗膝内翻骨关节炎[J]. 中华骨科杂志, 2010, 30(6): 558-562. DOI: 10.3760/cma.j.issn.0253-2352.2010.06.005.
[3] Kumagai K, Fujimaki H, Yamada S, et al. Difference in the early postoperative change of the joint line convergence angle between opening wedge and closed wedge high tibial osteotomies[J]. J Orthop Surg Res, 2021, 16(1): 66. DOI: 10.1186/s13018-021-02214-x.
[4] Lau LCM, Chui ECS, Fan JCH, et al. Patient-specific instrumentation (PSI) Referencing High Tibial Osteotomy Technological Transfer and Education: protocol for a double-blind, randomised controlled trial (PROTECTED HTO Trial)[J]. BMJ Open, 2021, 11(2): e041129. DOI: 10.1136/bmjopen-2020-041129.
[5] Ollivier B, Berger P, Depuydt C, et al. Good long-term survival and patient-reported outcomes after high tibial osteotomy for medial compartment osteoarthritis[J]. Knee Surg Sports Traumatol Arthrosc, 2021, 29(11): 3569-3584. DOI: 10.1007/s00167-020-06262-4.
[6] Fucentese SF, Meier P, Jud L, et al. Accuracy of 3D-planned patient specific instrumentation in high tibial open wedge valgisation osteotomy[J]. J Exp Orthop, 2020, 7(1): 7. DOI: 10.1186/s40634-020-00224-y.
[7] Kim HJ, Park J, Park KH, et al. Evaluation of accuracy of a three-dimensional printed model in open-wedge high tibial osteotomy[J]. J Knee Surg, 2019, 32(9): 841-846. DOI: 10.1055/s-0038-1669901.
[8] 刘洋, 梁涛, 张磊, 等. 3D打印辅助胫骨高位开放截骨联合关节镜治疗膝内翻畸形临床疗效分析[J]. 中国临床解剖学杂志, 2020, 38(1): 67-72. DOI: 10.13418/j.issn.1001-165x.2020.01.014.
[9] Yang CS, Chen CF, Luo CA, et al. Clinical experience using a 3d-printed patient-specific instrument for medial opening wedge high tibial osteotomy[J]. BioMed Res Int, 2018, e9246529: 1-9. DOI: 10.1155/2018/9246529.
[10]Kellgren JH, Lawrence JS. Radiological assessment of osteoarthrosis[J]. Ann Rheum Dis, 1957, 16(4): 494-502. DOI: 10.1136/ard.16.4.494.
[11]柳剑, 李兵, 王兴山, 等. TomoFix 3D打印导板在胫骨高位截骨术中的应用方法[J]. 实用骨科杂志, 2021, 27(10): 955-957. DOI: 10.13795/j.cnki.sgkz.2021.10.020.
[12]王兴山, 黄野, 柳剑, 等. 3D打印截骨导板辅助胫骨高位截骨术的准确性和安全性研究[J]. 实用骨科杂志, 2021, 27(10): 865-869. DOI: 10.13795/j.cnki.sgkz.2021.10.001.
[13]孙茂淋, 何锐, 郭林, 等. 开放楔形胫骨高位截骨术的临床应用及研究现状[J]. 中国修复重建外科杂志, 2019, 33(5): 640-643. DOI: 10.7507/1002-1892.201901014.
[14]Atkinson HF, Birmingham TB, Primeau CA, et al. Association between changes in knee load and effusion-synovitis: evidence of mechano-inflammation in knee osteoarthritis using high tibial osteotomy as a model[J]. Osteoarthritis Cartilage, 2021, 29(2): 222-229. DOI: 10.1016/j.joca.2020.11.007.
[15]Kim HJ, Park J, Shin JY, et al. More accurate correction can be obtained using a three-dimensional printed model in open-wedge high tibial osteotomy[J]. Knee Surg Sports Traumatol Arthrosc, 2018, 26(11): 3452-3458. DOI: 10.1007/s00167-018-4927-1.
[16]Jud L, Fürnstahl P, Vlachopoulos L, et al. Malpositioning of patient-specific instruments within the possible degrees of freedom in high-tibial osteotomy has no considerable influence on mechanical leg axis correction[J]. Knee Surg Sports Traumatol Arthrosc, 2020, 28(5): 1356-1364. DOI: 10.1007/s00167-019-05432-3.
[17]Han SB, In Y, Oh KJ, et al. Complications associated with medial opening-wedge high tibial osteotomy using a locking plate: a multicenter study[J]. J arthroplasty, 2019, 34(3): 439-445. DOI: 10.1016/j.arth.2018.11.009.
[18]Jingbo C, Mingli F, Guanglei C, et al. Patellar height is not altered when the knee axis correction is less than 15 degrees and has good short-term clinical outcome[J]. J Knee Surg, 2020, 33(6): 536-546. DOI: 10.1055/s-0039-1681051.
[19]Yamamuro Y, Kabata T, Goshima K, et al. Change in leg length after open-wedge high tibial osteotomy can be predicted from the opening width: a three-dimensional analysis[J]. Knee, 2021, 30: 185-194. DOI: 10.1016/j.knee.2021.04.010.
[20]刘云涛, 张新安, 王鹏, 等. 3D打印技术在胫骨高位截骨治疗膝内翻畸形骨关节炎中的临床应用[J]. 中华创伤骨科杂志, 2019, 21(3): 247-253. DOI: 10.3760/cma.j.issn.1671-7600.2019.03.012.
[21]高小康, 韩守江, 张元华, 等. 3D打印截骨导板在内侧开放胫骨高位截骨术中的应用[J]. 中国骨与关节损伤杂志, 2020, 35(2): 137-140. DOI: 10.7531/j.issn.1672-9935.2020.02.007.
基金
安徽省重点研究与开发计划项目（201904b11020032）；安徽医科大学基础与临床合作研究提升计划项目（2020xkjT040）；安徽医科大学第二附属医院临床研究培育计划项目（2020LCZD20）；安徽省转化医学研究院研究基金（2022zhyx-C44）; 西藏自治区自然科学基金组团式援藏医学项目
PDF(3136 KB)
京ICP备08002354号-3
