基于3D打印个性化截骨导板在内翻膝患者膝关节双间室置换术中的应用

doi:10.3969/j.issn.1006-5725.2024.17.016

Abstract

Abstract:

Objective To evaluate the clinical efficacy of a rapid 3D-printed patient-specific osteotomy guide in knee replacement surgery， and provide guidance for its widespread clinical application. Methods A total of 80 patients with end-stage knee osteoarthritis who had undergone Total Knee Arthroplasty （TKA） were selected and randomly divided into two groups. The first group comprised 40 cases （40 knees） that underwent traditional TKA， while the second group consisted of 40 patients （40 knees） in the 3D-printed osteotomy guide group. Various parameters， including surgery duration， intraoperative blood loss， time to ambulation after surgery， mechanical axis angle between femur and tibia post-surgery， Visual Analog Scale （VAS） score， Hospital for Special Surgery （HSS） knee score， Western Ontario and McMaster Universities Osteoarthritis Index （WOMAC） score， range of motion （ROM） of the knee， and other indicators were analyzed separately for both groups. Statistical analyses were conducted. Results All the patients underwent surgery smoothly and were followed up for 3 ~ 12 months. In comparison to the traditional osteotomy guide group， the 3D-printed osteotomy guide group demonstrated significantly shorter surgery duration （P < 0.05）， reduced intraoperative blood loss， earlier time to first ambulation after surgery （P < 0.05）， lower postoperative VAS score， and smaller mechanical axis angle between the femur and tibia after surgery （P < 0.01）. At 6 months post-surgery， both groups showed significantly improved KSS scores compared to preoperative values （P < 0.01）. The KSS score of the 3D-printed guide group was higher than that of the traditional surgical guide group at 6 months after surgery （P < 0.05）， but there was no statistical difference in KSS scores between the two groups （P > 0.05）. WOMAC scores for both groups decreased over time at 3 and 6 months post-surgery compared to preoperative scores （P < 0.05）. At these time points， WOMAC scores were lower in the 3D-printed guide group than in the traditional osteotomy guide group （P < 0.05）. One case of hematocele and infection occurred in the traditional osteotomy guide group； however， successful discharge was achieved following re-debridement while preserving the prosthesis. None of the surgical patients experienced complications such as neurovascular injury， deep vein thrombosis， prosthesis loosening or periprosthetic fractures. Conclusion Compared to conventional total knee arthroplasty （TKA） surgery， the utilization of a rapid 3D-printed osteotomy guide for knee replacement presents several advantages， including reduced surgical operation duration， minimal intraoperative blood loss， precise and expeditious osteotomies， accelerated postoperative recovery， and heightened patient satisfaction during medical consultations. Notably， its clinical efficacy surpasses that of traditional approaches.

Key words: total knee arthroplasty, 3D printing, knee osteoarthritis, knee varus, osteotomy guide plate

CLC Number:

R684.3

Binbin ZHANG,Yongrui WU,Chao LI,Kai FAN,Jingtang ZHANG. Clinical application of personalized osteotomy guide based on rapid 3D printing in knee arthroplasty[J]. The Journal of Practical Medicine, 2024, 40(17): 2448-2453.

Figures/Tables 10

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References 25

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临床资料	传统手术组	3D打印导板组	t/χ²值	P值
例数	40	40
男性	19（47.50）	16（40.00）	0.457	0.499
年龄（x ± s）/岁	67.75 ± 5.45	66.25 ± 6.25	1.144	0.256
病程（x ± s）/月	10.25 ± 1.25	9.85 ± 2.45	0.919	0.361
患膝（左侧）	24（60.00）	25（62.50）	0.053	0.818
基础疾病
高血压	15（37.50）	16（40.00）	0.053	0.818
高血脂	13（32.50）	12（30.00）	0.058	0.809
高血糖	12（30.00）	11（27.50）	0.061	0.805

组别	例数	术后3 d	术后1个月	术后3个月
传统手术组	40	45.67 ± 5.03	85.12 ± 3.87	107.22 ± 5.41
3D打印导板组	40	57.07 ± 4.92	90.22 ± 4.66	107.77 ± 5.28
t值		10.247	5.325	0.460
P值		< 0.001	< 0.001	> 0.05

组别	例数	手术时长（min）	术中出血量（mL）	术后首次下床时间（h）	术后股骨与胫骨机械轴夹角（°）
传统手术组	40	100.52 ± 7.68	117.52 ± 12.39	26.62 ± 5.05	1.97 ± 0.16
3D打印导板组	40	83.07 ± 6.38	83.52 ± 2.32	16.15 ± 2.08	2.55 ± 0.23
t值		11.054	17.059	12.124	13.093
P值		<0.001	<0.001	<0.05	<0.001

组别	例数	术前	术后1个月	术后3个月
传统手术组	40	6.57 ± 0.90	5.75 ± 0.80	2.70 ± 0.72
3D打印导板组	40	6.82 ± 0.87	4.75 ± 1.46	1.77 ± 0.57
t值		1.25	3.78	6.32
P值		> 0.05	< 0.01	< 0.01

组别	例数	KSS评分	KSS功能评分
传统手术组术前	40	57.75 ± 3.11	58.20 ± 1.96
3D打印导板组术前	40	58.02 ± 2.22	58.12 ± 3.62
t值		0.446	0.122
P值		> 0.05	> 0.05
传统手术组术后	40	90.07 ± 1.67	90.07 ± 1.71
3D打印导板组术后	40	89.52 ± 1.50	92.27 ± 1.44
t值		1.549	6.224
P值		> 0.05	< 0.05

Clinical application of personalized osteotomy guide based on rapid 3D printing in knee arthroplasty

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组别	例数	术前	术后3个月	术后6个月
传统手术组	40	76.72 ± 1.43	20.95 ± 0.90	12.27 ± 0.81
3D打印导板组	40	76.50 ± 1.33	23.37 ± 1.14	12.17 ± 1.23
t值		0.712	10.537	0.429
P值		> 0.05	< 0.05	> 0.05

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