3D打印导航模板在全膝关节置换术中的应用
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摘要
背景:随着3D打印技术在医学领域的拓展,将3D打印个体化器械运用于关节置换手术已成为研究热点。目的:设计一种3D打印导航模板,探究其在全膝关节置换术(TKA)中的应用及临床效果。方法:选择2017年2月至2018年2月间具有TKA手术指征的患者60例。其中类风湿性关节炎20例,膝骨关节炎40例。采用随机数字表法分为传统手术组和3D打印导板组,每组各30例,分别行传统TKA及3D打印导航模板辅助下TKA。术后复查假体位置,记录并比较两组患者术中失血量、手术时间、术后引流量、拔除引流时间,及术前与术后6个月髋膝踝角(HKA)、美国特种外科医院膝关节评分(HSS)与美国膝关节协会评分(KSS)。结果:3D打印导板组患者术中失血量及术后引流量均少于传统手术组患者,手术时间长于传统手术组患者,且差异均有统计学意义(t=28.008、17.429、8.256,P均<0.001);但两组患者术后拔除引流时间差异无统计学意义。所有患者随访7～12个月,平均随访(9.0±3.9)个月。两组患者术后6个月HKA、HSS评分、KSS评分均较术前升高,且差异均有统计学意义(传统手术组:t=7.825、33.342、23.906,P均<0.001;3D打印导板组:t=19.672、33.831、23.619,P均<0.001);但两组患者术后6个月HKA、HSS评分、KSS评分差异均无统计学意义。结论:3D打印导航模板辅助TKA是一种符合现代微创精准理念的手术方式,术后近期效果满意。其具有创伤小、旋转对线精准的特点,但也存在手术时间略微延长的不足。
Background: With the development of 3D printing technology in the medical field, the application of 3D printing in-dividualized instruments in joint replacement is becoming a research hotspot. Objective: To design a 3D printing navigationtemplate and to explore its clinical effects in total knee arthroplasty(TKA). Methods: Sixty patients with TKA operation indica-tions from February 2017 to February 2018 were randomly divided into 3D printing navigation template group and traditionalsurgery group(n=30). There were 20 cases of rheumatoid arthritis and 40 cases of knee osteoarthritis. The position of the pros-thesis was reexamined postoperatively. Operative time, intraoperative blood loss, post-operation drainage, drainage time, hip-knee-ankle(HKA) angle, knee score of Hospital for Special Surgery(HSS) and American Knee Association Score(KSS) werecompared between the two groups. Results: The intraoperative blood loss and post-operation drainage were both significantlyless in the 3D printing navigation template group than those in the traditional surgery group(t=28.008, 17.429, P<0.001). Theoperative time in the 3D printing navigation template group was significantly longer than that in the traditional surgery group(t=8.256, P<0.001). But there was no significant difference in drainage time between the two groups. All patients were followedup for(9.0±3.9) months on average(range, 7-12 months). Compared with preoperative ones, HKA, HSS and KSS scores weresignificantly increased at 6 months after surgery in both 3D printing group(t=19.672, 33.831, 23.619, P<0.001) and traditionalsurgery group(t=7.825, 33.342, 23.906, P<0.001). However, there were no significant differences in HKA, HSS or KSS scorebetween the two groups at 6 months after surgery. Conclusions: TKA assisted by 3D printing navigation template is a surgicalmethod with the modern concept of minimally invasive precision. It is characterized by small trauma, accurate rotational align-ment and satisfactory short-term results, but it may slightly prolong operation time.
Background: With the development of 3D printing technology in the medical field, the application of 3D printing in-dividualized instruments in joint replacement is becoming a research hotspot. Objective: To design a 3D printing navigationtemplate and to explore its clinical effects in total knee arthroplasty(TKA). Methods: Sixty patients with TKA operation indica-tions from February 2017 to February 2018 were randomly divided into 3D printing navigation template group and traditionalsurgery group(n=30). There were 20 cases of rheumatoid arthritis and 40 cases of knee osteoarthritis. The position of the pros-thesis was reexamined postoperatively. Operative time, intraoperative blood loss, post-operation drainage, drainage time, hip-knee-ankle(HKA) angle, knee score of Hospital for Special Surgery(HSS) and American Knee Association Score(KSS) werecompared between the two groups. Results: The intraoperative blood loss and post-operation drainage were both significantlyless in the 3D printing navigation template group than those in the traditional surgery group(t=28.008, 17.429, P<0.001). Theoperative time in the 3D printing navigation template group was significantly longer than that in the traditional surgery group(t=8.256, P<0.001). But there was no significant difference in drainage time between the two groups. All patients were followedup for(9.0±3.9) months on average(range, 7-12 months). Compared with preoperative ones, HKA, HSS and KSS scores weresignificantly increased at 6 months after surgery in both 3D printing group(t=19.672, 33.831, 23.619, P<0.001) and traditionalsurgery group(t=7.825, 33.342, 23.906, P<0.001). However, there were no significant differences in HKA, HSS or KSS scorebetween the two groups at 6 months after surgery. Conclusions: TKA assisted by 3D printing navigation template is a surgicalmethod with the modern concept of minimally invasive precision. It is characterized by small trauma, accurate rotational align-ment and satisfactory short-term results, but it may slightly prolong operation time.
引文
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[6]牛鸣,马飞,马菊蓉,等.基于3D打印的个性化截骨技术与传统方式行全膝关节表面置换的临床对比.南方医科大学学报,2017,37(11):1467-1475.
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[11]Maderbacher G,Baier C,Springorum HR,et al.Impact of axial component alignment in total knee arthroplasty on lower limb rotational alignment:an in vitro study.J Knee Surg,2017,30(4):372-377.
[12]Lee JK,Lee S,Chun SH,et al.Rotational alignment of femoral component with different methods in total knee arthroplasty:a randomized,controlled trial.BMC Musculoskelet Disord,2017,18(1):217.
[13]Tang WM,Zhu YH,Chiu KY.Axial alignment of the lower extremity in Chinese adults.J Bone Joint Surg Am,2000,82-A(11):1603-1608.
[14]Hsu RW,Himeno S,Coventry MB,et al.Normal axial alignment of the lower extremity and load-bearing distribution at the knee.Clin Orthop Relat Res,1990(255):215-227.
[15]崔建强,孙德麟,曲军杰,等.3D打印导航模板在SandersⅡ型跟骨骨折中的应用.中华骨与关节外科杂志,2018,11(8):566-569.
[16]付君,倪明,陈继营,等.个性化3D打印多孔钛合金加强块重建重度髋臼骨缺损的早期临床疗效研究.中华骨与关节外科杂志,2018,11(6):401-407.
[17]史玉林,王炳武,刘伟强,等.3D打印及术前数字化设计辅助椎弓根置钉治疗寰枢椎不稳的临床疗效.中华骨与关节外科杂志,2018,11(10):721-725.
[18]李杨,田华,耿霄.计算机导航系统、3D打印截骨导板与传统器械对全膝关节置换术手术时间和下肢力线恢复的影响.中华医学杂志,2018,98(27):2157-2161.
[19]Qiu B,Liu F,Tang B,et al.Clinical study of 3D imaging and3D printing technique for patient-specific instrumentation in total knee arthroplasty.J Knee Surg,2017,30(8):822-828.
[2]di Laura FG,Filardo G,Giunchi D,et al.Risk of falls in patients with knee osteoarthritis undergoing total knee arthroplasty:a systematic review and best evidence synthesis.J Orthop,2018,15(3):903-908.
[3]Ng CK,Chen JY,Yeh J,et al.Distal femoral rotation correlates with proximal tibial joint line obliquity:a consideration for kinematic total knee arthroplasty.J Arthroplasty,2018,33(6):1936-1944.
[4]Aihara AY,Cardoso FN,Debiex P,et al.Femoral component axial rotation in the gap-balancing approach to total knee arthroplasty:measurement by computed tomography.J Arthroplasty,2018,33(4):1222-1230.
[5]Schiapparelli FF,Amsler F,Hirschmann MT.The type of approach does not influence TKA component position in revision total knee arthroplasty-A clinical study using 3D-CT.Knee,2018,25(3):473-479.
[6]牛鸣,马飞,马菊蓉,等.基于3D打印的个性化截骨技术与传统方式行全膝关节表面置换的临床对比.南方医科大学学报,2017,37(11):1467-1475.
[7]Lee CM,Dhillon MK,Sulaiman MA.A computer-assisted,tibia-first technique for improved femoral component rotation in total knee arthroplasty.Arthroplast Today,2018,4(1):78-84.
[8]Lee SS,Lee YI,Kim DU,et al.Factors affecting femoral rotational angle based on the posterior condylar axis in gapbased navigation-assisted total knee arthroplasty for valgus knee.PLoS One,2018,13(5):e197335.
[9]Lee JK,Lee S,Chun SH,et al.Rotational alignment of femoral component with different methods in total knee arthroplasty:a randomized,controlled trial.BMC Musculoskelet Disord,2017,18(1):217.
[10]van Jonbergen HW,Westerbeek RE.Femoral component rotation in patellofemoral joint replacement.Knee,2018,25(3):485-490.
[11]Maderbacher G,Baier C,Springorum HR,et al.Impact of axial component alignment in total knee arthroplasty on lower limb rotational alignment:an in vitro study.J Knee Surg,2017,30(4):372-377.
[12]Lee JK,Lee S,Chun SH,et al.Rotational alignment of femoral component with different methods in total knee arthroplasty:a randomized,controlled trial.BMC Musculoskelet Disord,2017,18(1):217.
[13]Tang WM,Zhu YH,Chiu KY.Axial alignment of the lower extremity in Chinese adults.J Bone Joint Surg Am,2000,82-A(11):1603-1608.
[14]Hsu RW,Himeno S,Coventry MB,et al.Normal axial alignment of the lower extremity and load-bearing distribution at the knee.Clin Orthop Relat Res,1990(255):215-227.
[15]崔建强,孙德麟,曲军杰,等.3D打印导航模板在SandersⅡ型跟骨骨折中的应用.中华骨与关节外科杂志,2018,11(8):566-569.
[16]付君,倪明,陈继营,等.个性化3D打印多孔钛合金加强块重建重度髋臼骨缺损的早期临床疗效研究.中华骨与关节外科杂志,2018,11(6):401-407.
[17]史玉林,王炳武,刘伟强,等.3D打印及术前数字化设计辅助椎弓根置钉治疗寰枢椎不稳的临床疗效.中华骨与关节外科杂志,2018,11(10):721-725.
[18]李杨,田华,耿霄.计算机导航系统、3D打印截骨导板与传统器械对全膝关节置换术手术时间和下肢力线恢复的影响.中华医学杂志,2018,98(27):2157-2161.
[19]Qiu B,Liu F,Tang B,et al.Clinical study of 3D imaging and3D printing technique for patient-specific instrumentation in total knee arthroplasty.J Knee Surg,2017,30(8):822-828.