中国组织工程研究

中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (18): 2789-2793.doi: 10.3969/j.issn.2095-4344.3834

• 数字化骨科 digital orthopedics •    下一篇

3D打印手术导板在膝关节内外翻畸形患者全膝关节置换中的应用

黄辰宇1，2，3，唐  成1，2，3，魏  波1，2，3，李佳怡1，2，3，李旭祥1，2，3，张惠康2，3，徐  燕2，3，姚庆强1，2，3，王黎明1，2，3   

  1. 1南京医科大学附属南京医院骨科，江苏省南京市   210006；2南京医科大学数字医学研究所，江苏省南京市   210006；3江苏省数字医学与3D打印临床工程研究中心，江苏省南京市   210006
  • 收稿日期:2020-05-11 修回日期:2020-05-16 接受日期:2020-07-31 出版日期:2021-06-28 发布日期:2021-01-11
  • 通讯作者: 王黎明，硕士，主任医师，南京医科大学附属南京医院骨科，江苏省南京市 210006；南京医科大学数字医学研究所，江苏省南京市 210006；江苏省数字医学与3D打印临床工程研究中心，江苏省南京市 210006
  • 作者简介:黄辰宇，男，1992年生，江苏省南通市人，汉族，2019年南京医科大学毕业，硕士，主要从事骨软骨一体化修复和髋膝关节置换方面的研究。
  • 基金资助:
    江苏省科技项目(BE2019679)，项目负责人：王黎明；南京市科技发展计划(201805001)，项目负责人：王黎明；国家自然科学基金(81972042)，项目负责人：王黎明

Application of three-dimensional printing guide plate in total knee arthroplasty for patients with varus and valgus deformity

Huang Chenyu1, 2, 3, Tang Cheng1, 2, 3, Wei Bo1, 2, 3, Li Jiayi1, 2, 3, Li Xuxiang1, 2, 3, Zhang Huikang2, 3, Xu Yan2, 3, Yao Qingqiang1, 2, 3, Wang Liming1, 2, 3   

  1. 1Department of Orthopedics, Nanjing Hospital Affiliated to Nanjing Medical University, Nanjing 210006, Jiangsu Province, China; 2Institute of Digital Medicine, Nanjing Medical University, Nanjing 210006, Jiangsu Province, China; 3Jiangsu Digital Medicine and 3D printing Clinical Engineering Research Center, Nanjing 210006, Jiangsu Province, China 
  • Received:2020-05-11 Revised:2020-05-16 Accepted:2020-07-31 Online:2021-06-28 Published:2021-01-11
  • Contact: Wang Liming, Master, Chief physician, Department of Orthopedics, Nanjing Hospital Affiliated to Nanjing Medical University, Nanjing 210006, Jiangsu Province, China; Institute of Digital Medicine, Nanjing Medical University, Nanjing 210006, Jiangsu Province, China; Jiangsu Digital Medicine and 3D printing Clinical Engineering Research Center, Nanjing 210006, Jiangsu Province, China
  • About author:Huang Chenyu, Master, Department of Orthopedics, Nanjing Hospital Affiliated to Nanjing Medical University, Nanjing 210006, Jiangsu Province, China; Institute of Digital Medicine, Nanjing Medical University, Nanjing 210006, Jiangsu Province, China; Jiangsu Digital Medicine and 3D printing Clinical Engineering Research Center, Nanjing 210006, Jiangsu Province, China
  • Supported by:
    the Science and Technology Project in Jiangsu Province, No. BE2019679 (to WLM); the Nanjing Science and technology development plan, No. 201805001 (to WLM); the National Natural Science Foundation of China, No. 81972042 (to WLM) 

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摘要：

文题释义：
3D 打印个性化截骨导板辅助行全膝关节置换：是术前将患者膝关节的 CT 扫描数据用计算机软件进行处理，在计算机上进行力线的调整，得出最佳的假体横截面对线，再通过三维成像技术制作截骨模板，此截骨模板具有个性化、截骨角度更确切等优点，术中股骨远端及后髁截骨量、胫骨截骨后倾角度与截骨量及术中使用假体的型号都在术前用计算机测定出来。
3D 打印个性化截骨导板辅助行全膝关节置换的优势：与传统的全膝关节置换相比，其不需要术中使用髓内外导向器反复测量力线，不需要反复测定股骨远端及后髁的截骨量、胫骨截骨的后倾角度与截骨量；也不用反复安放假体试模查看其与关节的匹配程度，尤为重要的是术中无需使用髓内导向器，不需要打开股骨髓腔，这使得术中出血量降低，输血率下降；另外还可以降低由于使用髓内导向器所增加的脂肪栓塞发生率。

背景：近年来 3D打印技术在导航骨折内固定植入、脊柱外科螺钉置入及巨大骨缺损修复重建领域应用较为广泛，但是将3D打印导航模板运用于膝关节内外翻患者全膝关节置换手术的相关报道较少。
目的：对比3D打印手术导板辅助全膝关节置换和传统全膝关节置换治疗膝关节内外翻骨性关节炎的效果。
方法：选择2019年1月至2020年2月南京医科大学附属南京医院收治的膝关节内外翻骨性关节炎患者39例，其中女18例，男21例，年龄55-83岁，随机分2组：试验组(n=20)在3D打印手术导板辅助下进行全膝关节置换，对照组(n=19)进行传统的全膝关节置换。术后拍摄X射线片，测量冠状面胫骨组件角、矢状面胫骨组件角、冠状面股骨组件角、矢状面股骨组件角、髋膝踝角度及下肢力线角度；记录两组住院时间、手术时间、术中出血量和术后引流量。术后1 d、1周、2周、1个月、3个月时，进行目测类比评分及美国膝关节协会(KSS)评分。试验通过南京医科大学附属南京医院伦理委员会批准。
结果与结论：①两组术后的冠状面胫骨组件角、矢状面胫骨组件角、冠状面股骨组件角、矢状面股骨组件角及髋膝踝角度偏移值均<3°，试验组对下肢力线角度的调整效果优于对照组(P < 0.05)；②试验组的手术时间、术中出血量与术后引流量少于对照组(P < 0.05)，两组患者住院时间比较差异无显著性意义(P > 0.05)；③试验组术后1 d、1周的目测类比评分低于对照组(P < 0.05)，KSS评分高于对照组(P < 0.05)；④结果表明，对于膝关节严重内外翻患者，3D打印手术导板辅助下的膝关节置换提高了手术精度，节省了术中时间。

关键词: 骨, 植入物, 假体, 3D打印导板, 全膝关节置换, 内外翻畸形, 骨关节炎

Abstract: BACKGROUND: In recent years, three-dimensional (3D) printing technology has been widely used in the fields of navigation fracture internal fixation, spinal screw implantation and huge bone defect repair and reconstruction. However, there are few reports on the application of 3D printing navigation template in total knee arthroplasty for patients with varus and valgus knee joint. 
OBJECTIVE: To compare the effect of 3D printing surgical guide plate assisted total knee arthroplasty and traditional total knee arthroplasty in the treatment of knee varus and valgus osteoarthritis.
METHODS: Totally 39 patients with knee osteoarthritis were selected in Nanjing Hospital Affiliated to Nanjing Medical University from January 2019 to February 2020, including 18 females, 21 males, aged 55-83 years old, and randomly divided into two groups. Patients in the trial group (n=20) underwent total knee arthroplasty with 3D printing guide plate. Patients in the control group (n=19) underwent traditional total knee arthroplasty. X-ray films were taken after operation to measure the coronal tibial component angle, sagittal tibial component angle, coronal femoral component angle, sagittal femoral component angle, hip-knee-ankle angle, and angle of lower limb force line. The hospitalization time, operation time, intraoperative blood loss, and postoperative drainage volume were recorded in both groups. Visual analogue scores and American knee society knee scores were performed at 1 day, 1 week, 2 weeks, 1 month and 3 months after operation. The trial was approved by the Ethics Committee of Nanjing Hospital Affiliated to Nanjing Medical University.
RESULTS AND CONCLUSION: (1) The deviation values of coronal tibial component angle, sagittal tibial component angle, coronal femoral component angle, sagittal femoral component angle and hip-knee-ankle angle in the two groups were all < 3°, and the adjustment effect of the trial group on the angle of lower limb force line was better than that of the control group (P < 0.05). (2) The operation time, intraoperative blood loss and postoperative drainage volume of the trial group were less than those of the control group (P < 0.05). There was no significant difference in hospital stay between the two groups (P > 0.05). (3) The visual analogue scale scores of the trial group at 1 day and 1 week after operation were lower than those of the control group (P < 0.05), and the American knee society knee scores were higher than that of the control group (P < 0.05). (5) The results showed that for patients with severe varus and valgus of the knee joint, 3D printing surgical guide plate assisted knee arthroplasty improved the operation accuracy and saved the intraoperative time.

Key words: bone, implant, prosthesis, 3D printing guide plate, total knee arthroplasty, varus and valgus deformity, osteoarthritis

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