3D打印辅助股骨远端闭合截骨与股骨远端闭合截骨治疗膝外翻骨关节炎的比较

文题释义：3D打印技术：一种利用数字建模、分层打印的方式来构造物体的技术，属于快速成型技术。目前3D 打印技术已被广泛应用于工业制造、生物医疗等领域，该技术可通过数字建模、辅助材料及内植物打印等方式指导截骨矫形手术的术前设计、术中导向，进一步提高截骨精确度。股骨远端闭合截骨：通过股骨楔形截骨以达到纠正下肢力线的目的，常用于治疗股骨侧畸形造成的膝关节外翻型骨关节炎。背景：股骨远端闭合截骨治疗膝外翻型骨关节炎具有较好的疗效，但术中无法直接测量截骨角度，需要通过反复透视、调整截骨量来矫正力线，操作不当可能造成医源性旋转畸形。目的：比较应用3D打印技术辅助股骨远端闭合截骨与常规股骨远端闭合截骨治疗膝关节骨关节炎的疗效。方法：选择2014年1月至2018年2月莆田市第一医院收治的膝关节外翻所致骨关节炎患者28例(共37膝)，年龄28-60岁，随机分2组治疗：对照组11例(16膝)采用常规股骨远端闭合截骨结合锁定加压钢板植入治疗，试验组17例(21膝)采用3D打印模块辅助股骨远端闭合截骨结合锁定加压钢板植入治疗，记录手术时间与透视次数。比较两组治疗前后的KOOS评分、股胫角、股骨远端外侧角与骨折愈合时间。试验经莆田市第一医院伦理委员会批准。结果与结论：①试验组手术时间与透视次数少于对照组(P < 0.001)；②在KOOS评分中，两组术后疼痛、症状、日常生活、体育娱乐及生活质量方面的评分均较术前明显改善(P < 0.01)；术后两组间疼痛、症状、日常生活、体育娱乐及生活质量方面的评分比较差异无显著性意义(P > 0.05)；③两组术后的股胫角、股骨远端外侧角均较术前增大(P < 0.01)，术后两组间股胫角、股骨远端外侧角比较差异无显著性意义(P > 0.05)；④两组骨折愈合时间比较差异无显著性意义(P > 0.05)；⑤结果表明，股骨远端闭合截骨术治疗膝关节外翻骨关节炎可获得良好疗效，应用3D打印技术可简化截骨操作、减少手术时间及透视次数。ORCID: 0000-0003-0651-833X(陈国仙)中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Comparison of 3D printing assisted osteotomy of distal femur and osteotomy of distal femur in the treatment of genu valgus osteoarthritis

BACKGROUND:Closed osteotomy of distal femur has a good effect in the treatment of genu valgus osteoarthritis,but the angle of osteotomy cannot be measured directly during the operation.It is necessary to correct the force line through repeated fluoroscopy and adjustment of osteotomy amount.Improper operation may cause iatrogenic rotation deformity.OBJECTIVE:To compare the effect of 3D printing assisted osteotomy of distal femur with conventional osteotomy of distal femur in the treatment of knee osteoarthritis.METHODS:From January 2014 to February 2018,28 patients(37 knees in total)with osteoarthritis caused by genu valgus aged 28-60 years were enrolled from the First Hospital of Putian City.All patients were randomly divided into two groups.Patients in the control group(11 cases,16 knees)were treated with conventional closed osteotomy of distal femur combined with locking compression plate implantation.Patients in the experimental group(17 cases,21 knees)were treated with 3D printing module assisted with closed osteotomy of distal femur combined with locking compression plate.The operation time and times of fluoroscopy were recorded.The KOOS score,femorotibial angle,lateral angle of distal femur and fracture healing time were compared between the two groups before and after treatment.The experiment was approved by the Ethics Committee of the First Hospital of Putian City.RESULTS AND CONCLUSION:(1)Operation time and the times of fluoroscopy in the experimental group were less than those in the control group(P<0.001).(2)In the KOOS score,the scores of pain,symptoms,daily life,sports entertainment and quality of life in the two groups were significantly improved after surgery compared with those before surgery(P<0.01).There was no significant difference in the scores of pain,symptoms,daily life,sports entertainment and quality of life between the two groups(P>0.05).(3)Femorotibial angle and lateral angle of distal femur in both groups were larger than those before operation(P<0.01).There was no significant difference between the two groups in femorotibial angle and lateral angle of distal femur(P>0.05).(4)There was no significant difference in the healing time between the two groups(P>0.05).(5)The results showed that closed osteotomy of the distal femur can achieve good results in the treatment of genu valgus osteoarthritis.3D printing technology can simplify the osteotomy operation,reduce the operation time,and the times of fluoroscopy.