中国修复重建外科杂志

中国修复重建外科杂志

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

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目的 探讨 3D 打印技术辅助人工全膝关节置换术(total knee arthroplasty,TKA)治疗合并关节外畸形的膝骨关节炎(knee osteoarthritis,KOA)的临床疗效。 方法 2013 年 3 月—2015 年 12 月,收治 15 例(18 膝)合并关节外畸形的 KOA 患者。男 6 例(6 膝),女 9 例(12 膝);年龄 55~70 岁,平均 60.2 岁;病程 7~15 年,平均 10.8 年。单膝12例,双膝3例。膝关节学会评分系统(KSS)临床评分为(57.44±1.06)分,功能评分为(60.88±1.26)分。膝关节活动度为(72.22±0.18)°。下肢力线偏移(18.89±0.92)°。合并股骨侧畸形 8 例(10 膝),胫骨侧畸形 5 例(5 膝),股骨侧及胫骨侧畸形 2 例(3 膝)。术前 3D 打印骨骼模型、截骨导航模板并设计手术方案,选择合适的膝关节假体后实施 TKA。 结果 手术时间 65~100 min,平均 75.6 min;术中出血量 50~150 mL,平均 90.2 mL。术后均未出现切口愈合不良、感染、血栓等并发症。患者均获随访,随访时间 12~30 个月,平均 22 个月。末次随访时,X 线片示假体位置均良好,未发现松动、下沉;下肢力线偏移(2.00±0.29)°,与术前比较差异有统计学意义(t=13.120,P=0.007);KSS 临床评分为(87.50±0.88)分、功能评分为(81.94±1.41)分,与术前比较差异有统计学意义(t=27.553,P=0.000;t=35.551,P=0.000);膝关节活动度为(101.94±1.42)°,与术前比较差异有统计学意义(t=31.633,P=0.000)。 结论 对于合并关节外畸形的 KOA,采用 3D 打印技术辅助 TKA ,可达到个体化治疗、降低手术难度,有效矫正畸形,恢复患者膝关节功能的目的。

Objective To evaluate the effectiveness of total knee arthroplasty (TKA) using three-dimensional (3D) printing technology for knee osteoarthritis (KOA) accompanied with extra-articular deformity. Methods Between March 2013 and December 2015, 15 patients (18 knees) with extra-articular deformity and KOA underwent TKA. There were 6 males (6 knees) and 9 females (12 knees), aged 55-70 years (mean, 60.2 years). The mean disease duration was 10.8 years (range, 7-15 years). The unilateral knee was involved in 12 cases and bilateral knees in 3 cases. The clinical score was 57.44±1.06 and the functional score was 60.88±1.26 of Knee Society Score (KSS). The range of motion of the knee joint was (72.22±0.18)°. The deviation of mechanical axis of lower limb was (18.89±0.92)° preoperatively. There were 8 cases (10 knees) with extra-articular femoral deformity, 5 cases (5 knees) with extra-articular tibial deformity, and 2 cases (3 knees) with extra-articular femoral and tibial deformities. Bone models and the navigation templates were printed and the operation plans were designed using 3D printing technology. The right knee joint prostheses were chosen. Results The operation time was 65-100 minutes (mean, 75.6 minutes). The bleeding volume was 50-150 mL (mean, 90.2 mL). There was no poor incision healing, infection, or deep venous thrombosis after operation. All patients were followed up 12- 30 months (mean, 22 months). Prostheses were located in the right place, and no sign of loosening or subsidence was observed by X-ray examination. At last follow-up, the deviation of mechanical axis of lower limb was (2.00±0.29)°, showing significant difference when compared with preoperative one (t=13.120, P=0.007). The KSS clinical score was 87.50±0.88 and function score was 81.94±1.41, showing significant differences when compared with preoperative ones (t=27.553, P=0.000; t=35.551, P=0.000). The range of motion of knee was (101.94±1.42)°, showing significant difference when compared with preoperative one (t=31.633, P=0.000). Conclusion For KOA accompanied with extra-articular deformity, TKA using 3D printing technology has advantages such as individualized treatment, reducing the difficulty of operation, and achieving the satisfactory function.

关键词: 3D 打印技术; 人工全膝关节置换术; 关节外畸形; 膝关节; 骨关节炎

Key words: Three-dimensional printing technology; total knee arthroplasty; extra-articular deformity; knee; osteoarthritis

引用本文: 许志庆, 王武炼, 庄至坤, 张怡元. 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. 中国修复重建外科杂志, 2017, 31(8): 913-917. doi: 10.7507/1002-1892.201701075 复制

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