3D打印模板辅助关节置换治疗膝骨关节炎的前瞻性研究

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摘要目的通过前瞻性临床对照研究方法评估个性化3D打印截骨模板辅助全膝关节置换术治疗膝关节骨关节炎的疗效。方法前瞻性分析2015年1月至2016年1月在我院行全膝关节置换手术的60例膝关节骨关节炎患者。采用随机数表法将患者分为A、B两组，A组30例，在个性化3D打印截骨模板辅助下行人工膝关节置换术；B组30例，行传统人工膝关节置换术。分别记录两组患者手术时间、出血量、术后影像学资料及美国特种外科医院 (the hospital special surgery，HSS)评分，对两组数据进行对比统计分析。结果所有患者均完成手术并获得有效随访，两组均未出现严重术后并发症。A组患者平均手术时间(74.03±13.90)min，B组患者平均手术时间(87.47±10.97)min，差异有统计学意义(P＝0.024)；A组手术出血量(239.47±42.93)mL，B组手术出血量(388.57±38.81)mL，A组显著少于B组(P＝0.000)；A组术后股骨与胫骨机械轴夹角(mechanical femoral tibal angle，mFTA)为(0.98±0.27)°，B组术后mFTA为(2.02±0.45)°，两组比较差异具有统计学意义(P＝0.001)；术后3个月HSS评分，A、B两组分别为(90.53±6.89)分和(85.33±8.78)分，差异具有统计学意义(P＝0.019)。结论个体化3D打印截骨模板辅助下行人工膝关节置换术能缩短手术时间，减少手术出血，获得更精确的下肢力线，其近期临床疗效满意。

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关键词 ：骨关节炎, 关节置换, 截骨模具, 3D打印, 个性化

Abstract：Objective The clinical efficacy of patient-specific instrumentation(PSI) 3D-printed navigation template assisted total knee arthroplasty in the treatment of knee osteoarthritis was evaluated.Methods Sixty patients with knee osteoarthritis who underwent total knee arthroplasty in our hospital from January 2015 to January 2016 were included in this study.The patients were randomly divided into two groups：group A included 30 cases who underwent the PSI 3D printed osteotomy template assisted knee arthroplasty，group B included 30 cases who underwent conventional total knee arthroplasty.The operation time，bleeding volume，postoperative imaging data and HSS score were recorded and statistically analyzed.Results All the operations were successful and regular follow-up were achieved.No serious postoperative complications were observed.The mean operating time was (74.03±13.90)min in group A and (87.47±10.97)min in group B.The difference was statistically significant(P＝0.024).The bleeding volume was (239.47±42.93)mL in group A and was(388.57±38.81)mL in group B，which has the significant difference(P＝0.000).The postoperative femoral and tibial mechanical axis angle(mFTA) was(0.98±0.27)° in group A and (2.02±0.45)° in group B，which showed a significant difference(P＝0.001).The postoperative HSS score was(90.53±6.89) and (85.33±8.78) of group A and group B respectively，which also indicated a significant difference(P＝0.019).Conclusion The TKA with PSI 3D-printed navigation template has satisfactory short-term clinical efficacy with shorter operative time；less bleeding and more accurate limb alignment.

Key words： osteoarthritis arthroplasty osteotomy template 3D printed patient-specific instrumentation

作者简介: 余进伟(1967－ )，男，主任医师，焦作市第二人民医院骨科，454000。

引用本文:

余进伟 1，郭甲瑞 1，陈旭 1，王斌 1，朱光普 1，白伟 1，鲁亚杰 2. 3D打印模板辅助关节置换治疗膝骨关节炎的前瞻性研究[J]. 实用骨科杂志, 2018, 24(9): 782-836.
Yu Jinwei，Guo Jiarui，Chen Xu，et al. A Prospective Study on the Treatment of Knee Osteoarthritis with 3D-printed Navigation Template Assisted Arthroplasty. sygkzz, 2018, 24(9): 782-836.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2018/V24/I9/782

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