3D打印截骨导板辅助人工全膝关节置换术在重度膝内翻畸形中的应用观察

目的探析3D打印截骨导板技术辅助人工全膝关节置换术(TKA)在重度膝内翻畸形骨性关节炎中的应用，提高临床TKA的精准性。方法收集42名重度膝关节内翻畸形病人的临床资料进行分析。将病人采取随机数字表法分为2组，其中3D打印导板组21例(23膝)在3D打印截骨导板辅助下行TKA，传统手术组21例(21膝)接受传统TKA手术治疗。记录2组病人的手术时间、术中失血量、术后24 h引流量、术后股骨与胫骨机械轴夹角(aMFTA)以及膝关节KSS、WOMAC评分并进行统计分析。结果所有病人均成功实施手术并进行6个月随访。与传统手术组比较，3D打印导板组手术时间显著缩短(P<0.01)，术中失血量、术后24 h引流量均明显减少(P<0.01)；术后aMFTA低于传统手术组(P<0.01)。2组病人术后6个月KSS临床及功能评分均明显高于术前(P<0.01), 术后6个月3D打印导板组KSS功能评分高于传统手术组(P<0.05), 而2组KSS临床评分差异无统计学意义(P>0.05)。2组病人术后3个月和术后6个月WOMAC评分较术前均随着时间的增加而降低(P<0.01)；术后3个月，3D打印导板组评分低于传统手术组(P<0.05)。2组病人术后均未出现感染、神经损伤、深静脉血栓形成、假体松动脱位等并发症。结论3D打印截骨导板技术辅助TKA治疗膝关节重度内翻畸形较传统TKA手术兼备时间短、失血量少、手术截骨精准度提高和术后功能恢复快的优点，临床疗效更佳。

Application value of 3D printed osteotomy guide plate assisted artificial total knee arthroplasty in severe genu varus deformity

ObjectiveTo investigate the application value of 3D printing osteotomy technology assisted artificial total knee arthroplasty(TKA) in severe genu varus deformity to improve the accuracy of clinical TKA.MethodsThe clinical data of 42 patients with severe genu varus deformity were collected and analyzed.The patients were divided into two groups by random number table method.The 3D printing guide group(21 cases, 23 knees) were treated with 3D printed osteotomy guide plate assisted TKA, and the traditional surgical group were treated with traditional TKA.The operative time, intraoperative blood loss, 24 hours postoperative drainage, postoperative femoral and tibial mechanical shaft clamping angle(aMFTA) and knee joint KSS and WOMAC scores were recorded and statistically analyzed.ResultsAll patients were successfully operated and followed up for 6 months.Compared with the traditional surgery group, the operation time was significantly shortened(P<0.01), and the intraoperative blood loss and 24 hours postoperative drainage volume were significantly reduced in the 3D printing guide group(P<0.01).The postoperative aMFTA in 3D printing guide group was lower than that in traditional surgery group(P<0.01).After 6 months of surgery, the clinical and functional scores of KSS in two groups were significantly higher than those before surgery(P<0.01), the functional score of KSS in 3D printing guide group was higher than that in traditional surgery group(P<0.05), but there was no statistical significance in the clinical score of KSS between two groups(P>0.05).Compared with that before surgery, the WOMAC scores in two groups after 3 and 6 months of surgery decreased with the increase of time(P<0.01).After 3 months of surgery, the score of 3D printing guide group was lower than that of the traditional surgery group (P<0.05).No postoperative complications such as infection, nerve injury, deep vein thrombosis, prosthesis loosening and dislocation occurred in two groups.ConclusionsCompared with the traditional TKA surgery, the 3D printed osteotomy guide plate technology in the treatment of severe genu varus deformity has the advantages of shorter operation time, less blood loss, effective improving the surgical osteotomy accuracy, quick recovering the postoperative function and better clinical effects.