3D打印辅助胫骨高位开放截骨联合关节镜治疗膝内翻畸形临床疗效分析

目的观察3D打印截骨导板辅助胫骨高位开放式截骨术(OWHTO)联合关节镜清理治疗膝关节内翻畸形的临床疗效。方法回顾性分析2017年1月至2018年5月本院骨伤科膝关节内翻畸形患者15例(16膝)。术前利用3D打印截骨导板模拟OWHTO,根据理想的术后下肢力线(WBL),确定截骨部位、合页、高度、宽度、胫骨平台后倾角(PTS)及锁定钢板模型,进行截骨内固定。对术前术后WBL、Lysholm评分、PTS、髌骨高度指数(Caton指数)进行比较。结果随访15~24个月,WBL术前为(19.27±1.55)%,3D打印设计为(61.91±0.24)%,术后WBL恢复到(60.54±0.84)%,术前术后有统计学差异,3D打印设计与术后实际对比无统计学差异;术前术后PTS分别为(10.01±2.89)°,(10.06±0.09)°,无统计学差异;术后1年Lysholm评分(82.31±1.22)分,与术前(34.75±1.87)分比较差异有统计学意义。结论3D打印截骨导板辅助OWHTO,可实现精确截骨,显著改善下肢力线,减少术中透视,节省手术时间,是治疗膝关节内翻畸形安全有效的方法。

Clinical analysis of a 3D-printing technique assisted with opening wedge high tibial osteotomy combined with arthroscopy in the treatment of knee varus deformity

Objective To investigate the clinical efficacy of 3 D printing osteotomy guide plate assisted with opening wedge high tibial osteotomy(OWHTO)combined with arthroscopic debridement for treating knee varus deformity.Methods 15 cases patients(16 knees)with knee varus deformity in orthopedics department of our hospital from January 2017 to May 2018 were analyzed retrospectively.3 D printing osteotomy guide plate was used to simulate OWHTO before operation.According to the ideal postoperative weight-bearing line(WBL),the osteotomy site,the osteotomy hinge,the height,the width,and the posterior tibial slope(PTS)were determined to fix the osteotomy.The preoperative and postoperative WBL,Lysholm score,PTS,and patella height index(Caton index)were compared.Results After 15 to 24 months of follow-up,the WBL changed from preoperative(19.27±1.55)%to postoperative(60.54±0.84)%(P<0.05).There was statistical difference between the WBL before operation and the WBL after operation.The 3 D printing design before operation was(61.91±0.24)%,the PTS before operation and after operation were(10.01±2.89)°,(10.06±0.09)°respectively.There were no statistical difference between the preoperative and postoperative 3 D printing design and the PTS.The Lysholm score of 1 year after operation was(82.31±1.22),before operation was(34.75±1.87),there was statistical significance between the Lysholm score of 1 year after operation and after operation.Conclusions 3 D-printing technique assisted with opening wedge high tibial osteotomy combined with arthroscopy can achieve accurate osteotomy,improve the weight-bearing line significantly,reduce intraoperative perspection,save operation time,it is a safe and effective treatment of varus knee deformity.