摘要
[目的]比较3D打印个性化定制导板(patient-specific instruments,PSI)与常规截骨导板全膝关节置换术(total knee arthroplasty,TKA)的临床疗效。[方法]回顾性分析2019年1月—2021年12月行TKA治疗的100例患者临床资料。按照术前医患沟通结果,47例采用3D打印个性化定制截骨导板,53例采用常规截骨导板。比较两组围术期、随访及影像结果。[结果]个性组的手术时间[(80.0±12.7) min vs (66.1±12.3) min,P<0.05]、治疗费用[(5.0±1.0)万元vs (4.2±0.5)万元,P<0.05]均显著多于常规组;但是,前者的切口长度[(9.2±1.5) cm vs (14.0±2.6) cm,P<0.05]、术中失血量[(42.0±10.8) ml vs (50.1±12.8) ml,P<0.05]、术后引流量[(124.5±23.6) ml vs (154.3±20.7) ml,P<0.05]、下地行走时间[(24.0±4.5) h vs (28.3±5.6) h,P<0.05]、住院时间[(6.8±2.6) d vs (9.0±3.0) d,P<0.05]均显著优于后者。随访时间平均(18.0±3.5)个月,个性组恢复完全负重活动时间[(20.6±2.8)d vs (25.0±3.0) d,P<0.05]显著早于常规组。随时间推移,两组患者HSS评分、膝伸-屈ROM、VAS评分及WOMAC评分均显著改善(P<0.05),相应时间点,两组间上述指标的差异均无统计学意义(P>0.05)。影像方面,个性组FTA角偏差值[(1.0±0.3)°vs (2.2±0.7)°,P<0.05]、FFC角偏差值[(0.4±0.1)°vs (1.3±0.5)°,P<0.05]、FTC角偏差值[(0.2±0.0)°vs (1.2±0.3)°,P<0.05]、LFC角偏差值[(4.0±0.9)°vs (8.8±1.3)°,P<0.05]、LTC角偏差值[(0.5±0.1)°vs (0.9±0.3)°,P<0.05]均显著小于常规组。[结论] 3D打印个性化定制导板用于TKA可取得与传统TKA类似的效果。前者虽手术时间相对长,但在恢复下肢冠状位力线,减少术中失血量方面较后者有明显优势。
[Objective] To compare the clinical efficacy of 3D printed patient-specific instruments(PSI) versus conventional instruments(CI) in total knee arthroplasty(TKA).[Methods] A retrospective study was conducted on 100 patients who received primary unilateral TKA from January 2019 to December 2021.According to preoperative doctor-patient communication,47 patients had TKA performed with PIS,while the other 53 patients were treated with CI.The perioperative,follow-up and imaging data of the two groups were compared.[Results] Although the PSI group consumed significantly longer operation time [(80.0±12.7) min vs(66.1±12.3) min,P<0.05],and significantly higher hospital expense [(5.0±1.0) ten thousand yuan vs(4.2±0.5) ten thousand yuan,P<0.05] than the CI group,the former proved significantly superior to the latter in terms of incision length [(9.2±1.5) cm vs(14.0±2.6) cm,P<0.05],intraoperative blood loss [(42.0±10.8)ml vs(50.1±12.8) ml,P<0.05],postoperative drainage [(124.5±23.6) ml vs(154.3±20.7) ml,P<0.05],postoperative walking time [(24.0±4.5)hours vs(28.3±5.6) hours,P<0.05] and hospital stay [(6.8±2.6) days vs(9.0±3.0) days,P<0.05].The follow-up period lasted for(18.0±3.5)months on a mean,and the PSI group resumed full weight-bearing activities significantly earlier than the CI group [(20.6±2.8) days vs(25.0±3.0) days,P<0.05].The HSS score and knee extension-flexion ROM significantly increased,whereas the VAS and WOMAC scores significantly decreased in both groups over time(P<0.05),which proved not statistically significant between the two groups at any time points accordingly(P>0.05).Radiographically,the PSI group also proved significantly superior to the CI group in terms of FTA deviation[(1.0±0.3)° vs(2.2±0.7)°,P<0.05],FFC deviation [(0.4±0.1)° vs(1.3±0.5)°,P<0.05],FTC deviation [(0.2±0.0)° vs(1.2±0.3)°,P<0.05],LFC deviation [(4.0±0.9)° vs(8.8±1.3)°,P<0.05] and LTC deviation [(0.5±0.1)° vs(0.9±0.3)°,P<0.05].[Conclusion] The TKA with 3D-printed patient-specific instruments achiev
作者
杨建勋
吴斌
高鹏吉
YANG Jian-xun;WU Bin;GAO Peng-ji(Department of Traumatic Orthopedics,Linyi People's Hospital,Linyi 276002,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2023年第24期2243-2247,共5页
Orthopedic Journal of China
关键词
全膝关节置换术
3D打印个性化定制导板
下肢力线
total knee arthroplasty
3D-printed personalized osteotomy guider
alignment of the lower extremity
