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

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摘要目的评价3D打印截骨导板辅助胫骨高位截骨术的准确性和安全性。方法对2020年4月至2020年10月我院行3D打印导板辅助开放楔形行胫骨高位截骨术的22例(36膝)患者进行回顾性研究，其中男11例(16膝)，女11例(20膝)；平均年龄(41.1±15.8)岁。比较术前计划力线和术后力线的差异及胫骨平台后倾角的变化，统计手术时间、术中透视次数与术中、术后早期并发症情况。结果 22例平均手术时间(40.1±12.8)min，术中平均透视(13.3±4.5)次。胫骨近端内侧角(medial proximal tibial angle，MPTA)由术前(83.0±1.8)°矫正至术后(90.1±2.3)°，P＜0.001。下肢力线比值(weight bearing line ratio，WBLR)由术前的(22.6±9.7)%调整至术后的(52.9±3.8)%，P＜0.001。术后MPTA(90.1±2.3)°，与术前计划MPTA(90.4±2.2)°相比，差异无统计学意义(P＝0.159)。术后WBLR为(52.9±3.8)%，与术前目标WBLR(54.4±3.3)%相比，差异有统计学意义(P＝0.005)，差值(1.5±3.1)%。术后胫骨平台后倾角(posterior tibial slope，PTS)平均为(10.2±3.3)°，与术前PTS(10.4±3.5)°相比，差异无统计学意义(P＝0.077)。合页骨折2例，其中Takeuchi Ⅰ型骨折1例，Ⅲ型骨折1例，骨折均愈合良好，无移位及矫正力线丢失。结论 3D打印截骨导板辅助开放楔形胫骨高位截骨术力线矫正精确，可有效维持胫骨平台后倾，具有良好的准确性和安全性。

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关键词 ： 3D打印, 导板, 胫骨, 截骨术

Abstract：Objective To evaluate the accuracy and safety of high tibial osteotomy assisted by 3D printed guide.Methods A retrospective study was conducted on 22 patients (36 knees) who underwent medial open wedge high tibial osteotomy (OWHTO) assisted by 3D printed guide in our hospital from April 2020 to October 2020，including 11 males (16 knees) and 11 females (20 knees).The average age was (41.1±15.8)years.The differences between preoperative planned weight bearing line ratio(WBLR) and postoperative WBLR were compared，as well as the changes of posterior slope of the tibial plateau before and after operation.The operative time，frequency of intraoperative fluoroscopy，intraoperative and early postoperative complications were extracted. Results The average operation time was (40.1±12.8)min，and the frequency of fluoroscopy was (13.3±4.5).The medial proximal tibial angle (MPTA) was corrected from (83.0±1.8)° preoperatively to (90.1±2.3)° postoperatively，P＜0.001.The WBLR was adjusted from (22.6±9.7)% preoperatively to (52.9±3.8)% postoperatively，P＜0.001.There was no significant difference between the postoperative MPTA and the targeted MPTA value (90.4±2.2)° (P＝0.159).The postoperative WBLR (52.9±3.8)% was significantly different from the preoperative target WBLR (54.4±3.3)% (P＝0.005)，and the difference was (1.5±3.1)%.The posterior tibial slope(PTS) was (10.4±3.5)° preoperatively and (10.2±3.3)° postoperatively (P＝0.077).There were 2 cases of lateral hinge fracture in this group，including 1 case of Takeuchi type I fracture and 1 case of Takeuchi type Ⅲ fracture.The fracture healed well eventually，with no displacement or loss of correction.Conclusion OWHTO assisted by 3D printed guide can achieve precise correction of the WBL，while maintaining the slope of the tibial plateau，good accuracy and safety can be obtained.

Key words： 3D printing guide tibia osteotomy

通讯作者: 黄野

作者简介: 王兴山(1982－ )，男，副主任医师，北京积水潭医院矫形骨科，100035。

引用本文:

王兴山 1，黄野 1*，柳剑 1，崔雅南 2，刘刚 2，万叶彪 2. 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.
Wang Xingshan，Huang Ye，Liu Jian，et al. Accuracy and Safety Evaluation of Open Wedge High Tibial Osteotomy Assisted by 3D Printed Guide. sygkzz, 2021, 27(10): 865-869.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2021/V27/I10/865

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