导板辅助胫骨高位截骨术与经典截骨方式的临床对照研究

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摘要目的比较3D打印截骨导板辅助开放楔形胫骨高位截骨术与经典AO技术胫骨高位截骨术的临床结果。方法采用前瞻性随机对照研究纳入2020年3月至2020年12月的98例患者，其中90例患者符合入组标准，通过PASS软件提供的随机号码表进行随机分组。最终45例患者(70膝)入选实验组，男25例，女20例；年龄19~69岁，平均(40.48±14.95)岁；实验组患者在3D打印截骨导板辅助下行胫骨高位截骨术。另45例患者(59膝)入选对照组，男19例，女26例；年龄21~71岁，平均(48.16±16.65)岁；对照组患者应用经典AO技术行胫骨高位截骨术。两组患者术前均规划好目标力线并记录，计算并比较两组术后力线与规划目标力线的差异，术后胫骨后倾角的差异，记录手术时间、术中透视次数等指标，评估两组手术前后牛津膝关节评分(Oxford knee score，OKS)。结果术中透视次数：实验组(13.79±8.12)次，对照组(23.36±11.80)次，两组差异有统计学意义(P＜0.01)。术后与目标负重力线比值(weight bearing line ratio，WBLR)的差值比较：实验组(4.29±4.57)%，对照组(4.75±4.87)%，两组比较差异无统计学意义(P＝0.62)。患者术后负重力线与胫骨平台交叉点在计划点±10%内的患者比例：实验组75.81%，对照组73.33%，两组比较差异无统计学意义(P＝0.82)。患者术后与目标胫骨后倾角(posterior tibial slope，PTS)的差值：实验组(3.16±4.62) °，对照组(1.86±2.39) °，两组比较差异无统计学意义(P＝0.10)。术后较术前OKS评分改善差值：实验组(4.27±10.14)分，对照组(－1.83±12.67)分，两组比较差异有统计学意义(P＜0.01)。结论 3D打印截骨导板辅助胫骨高位截骨术与经典AO技术的胫骨高位截骨术比较，可显著降低术中透视次数，提高术后OKS评分。

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	刘源
	柳剑
	黄野
	王兴山
	刘庆
	崔亚南
	刘刚
	万叶彪

关键词 ：开放楔形胫骨高位截骨术, 截骨导板, 膝关节骨关节炎

Abstract：

Objective To compare the clinical outcomes of 3D printed cutting guides assisted open wedge high tibial osteotomy (OWHTO) to OWHTO with classic AO technique.Methods The clinical data of 98 patients from March to December 2020 were screened and a total of 90 patients met the grouping criteria and were randomized grouping by the random number list provided by PASS software.Finally，45 patients (70 knees) were selected for study group.The patients consisted of 25 males and 20 females，with ages ranging from 19~69 years，mean age (40.48±14.95)years.Patients in study group treated by 3D printed cutting guides assisted high tibial osteotomy (HTO) Another 45 patients (59 knees) were selected for control group.The patients consisted of 19 males and 26 females，with ages ranging from 21~71 years，mean age (48.16±16.65)years.Patients in control group treated by HTO with classical AO technique.The target alignments were planned and recorded before surgery.The differences between the postoperative alignments and the planned target alignments were compared in two groups.Postoperative posterior tibial slope (PTS)，operation time and intraoperative fluoroscopy times were recorded.The differences between preoperative and postoperative Oxford knee score (OKS) were also compared between two groups.Results Intraoperative fluoroscopy times in study group (13.79±8.12) was statistically significant less than control group (23.36±11.80) (P＜0.01).There was no significant difference of postoperative and target weight bearing line ratio (WBLR) in study group (4.29±4.57)% and control group (4.75±4.87)% (P＝0.62).The proportion of patients whose difference between postoperative and target WBLR within ±10% was 75.81% in study group and 73.33% in control group.There was no significant difference between two groups (P＝0.82).There was no significant difference of postoperative and target posterior tibial slope (PTS) in study group (3.16±4.62)° and control group (1.86±2.39)° (P＝0.10).The improvement of OKS in study group (4.27±10.14) was statistically significant higher than control group (－1.83±12.67) (P＜0.01).Conclusion Comparing to HTO with classic AO technique，3D printed cutting guides can significantly decrease the intraoperative fluoroscopy times and increase the postoperative OKS.

Key words： open wedge high tibial osteotomy cutting guides knee osteoarthritis

通讯作者: 黄野

作者简介: 刘源(1985－ )，男，医师，首都医科大学附属北京积水潭医院矫形骨科，gooey2008@gmail.com

引用本文:

刘源，柳剑，黄野，王兴山，刘庆，崔亚南，刘刚，万叶彪. 导板辅助胫骨高位截骨术与经典截骨方式的临床对照研究[J]. 实用骨科杂志, 2023, 29(11): 980-.
Liu Yuan，Liu Jian，Huang Ye，Wang Xingshan，Liu Qing，Cui Yanan，Liu Gang，Wan Yebiao. The Clinical Outcomes of Cutting Guides Assisted High Tibial Osteotomy Compares to Traditional Osteotomy. sygkzz, 2023, 29(11): 980-.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2023/V29/I11/980

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