摘要
目的探讨3D打印快速原型制造辅助全膝关节置换术(TKA)在膝关节骨关节炎(OA)治疗中的应用。方法将32例于南京市第一医院骨科拟行TKA的患者,简单随机法分为3D打印组和常规手术组两组,各组16例。3D打印组行基于膝关节CT数据的3D打印原型制造,常规手术组行常规的TKA。测量股骨与胫骨解剖轴,确定股骨远端与前后髁截骨平面及截骨量、胫骨平台截骨角度及截骨量、胫骨与股骨的假体型号,并与手术实际使用值对比。记录两组术中出血量、术后引流量、手术时间、术后并发症发生率,以及术后1 d与1、3、12个月的疼痛视觉模拟评分(VAS)与美国膝关节协会评分(KSS)。两组患者一般情况中计量资料采用双侧t检验,计数资料采用x2检验;股骨远端截骨厚度、胫骨平台截骨厚度、股骨外翻角、胫骨平台后倾角、术中出血量、手术时间、术后引流量、VAS与KSS评分采用两独立样本t检验。结果 3D打印组术前计划的股骨远端及胫骨平台截骨厚度与实际值无统计学差异(P均>0.05)。3D打印组的手术时间短于常规手术组,组间差异有统计学意义(t=-6.407,P<0.05);3D打印组的术后引流量明显少于常规手术组,组间差异有统计学意义(t=-8.665,P<0.05)。3D打印组术后无膝内外翻畸形、假体松动等并发症发生;3D打印组术后1 d、1个月的VAS评分、KSS评分均优于常规手术组,组间差异均有统计学意义(P均<0.05)。结论 3D打印可准确构建解剖原型,可提升TKA手术的精度与疗效。
Objective To investigate the application of three dimentional （3D） printing（3DP） technique assisted total knee arthroplasty （TKA） in the treatment of osteoarthritis （OA）. Methods Thirty-two patients with OA were randomly divided into two groups, the 3DP group and the non-3DP group. The patients in the 3DP group were examined using CT scanning. The anatomical data of ＊. dicom was rec6nstructed to ＊. STL data by M3D software. 3DP was performed using fused deposition modeling （FDM） technique. The femoral line of force （LOF）, tibial LOF and osteotomy data of femoral condyle and tibial plateau were examined by mimic operation procedure （MOP）. The sizes of prostheses for femur and tibia in MOP were obtained and compared to the data of actual operation. The operation time, intra- operative blood loss, post-operative drainage volume and hospital stay time, as well as the visual analogue scale （VAS） and knee society score （KSS） were recorded and compared to the non-3DP procedure group. All these data were analyzed by chi-square test and Student＇s t test. Results No significant difference of the osteotomy data of femoral condyle and tibial plateau was found between the implants for MOP and theactual operation （P〉0. 05）. The 3DP group had a shorter time of operation and smaller amount of post- operative wound drainage, compared to the non-3DP group （time of operation： t = -6. 407, P 〈 0. 05; wound drainage ： t = - 8. 665, P 〈 0. 05 ）. After 12 months of follow-up, no varus or vaigus deformity or prosthesis loosening was observed in the 3DP group. The 3DP group had a lower VAS score and a higher KSS score at day 1 and one month after the surgery, compared to the non-3DP group （all P 〈 0. 05 ）. Conclusion 3DP technique can build up an accuracy rapid prototyping for TKA which may be useful for surgical accuracy improvement, complication rate reduction and rapid rehabilitation.
出处
《中华关节外科杂志（电子版）》
CAS
2017年第2期11-16,共6页
Chinese Journal of Joint Surgery(Electronic Edition)
基金
江苏省社会发展科技计划项目(BE2015613)
南京市医学重点科技发展项目(ZKX15024)
关键词
骨关节炎
膝
打印
3D
关节成形术
置换
膝
Osteoarthritis, knee
Printing, three-dimensional
Arthroplasty, replacement, knee
