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

doi:10.13418/j.issn.1001-165x.2020.01.014

中国临床解剖学杂志 ›› 2020, Vol. 38 ›› Issue (1): 67-72.doi: 10.13418/j.issn.1001-165x.2020.01.014

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

刘洋，　梁涛，　张磊，　刘刚，　易刚，　郭晓光，　周鑫，　扶世杰

西南医科大学附属中医医院泸州市院士工作站，四川泸州 646000

收稿日期:2019-08-29 出版日期:2020-01-25 发布日期:2020-02-18
通讯作者: 扶世杰，主任医师，硕士生导师，E-mail：fushijieggj@126.com
作者简介:刘洋（1991-），男，江苏沭阳人，在读硕士，研究方向：骨关节的基础和临床研究，E-mail：liu_yang1222@163.com
基金资助:
泸州市院士工作站在建项目（20180101）；泸州市科技局项目（2012-S-38）；泸州市政府-西南医科大学联合课题（2018zszysrctdxm；2018zszysrctdxm；2018zszysrctdxm）

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

LIU Yang, LIANG Tao, ZHANG Lei, LIU Gang, YI Gang, GUO Xiao-guang, ZHOU Xin, FU Shi-jie

Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Academician Workstation in Luzhou, Sichuan Luzhou 646000, China

Received:2019-08-29 Online:2020-01-25 Published:2020-02-18

摘要/Abstract

摘要： 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。

关键词: , 膝内翻畸形；　胫骨高位截骨；　3D打印；　关节镜

Abstract: Objective　 To investigate the clinical efficacy of 3D 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. 3D 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 3D 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 3D 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　3D-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.

Key words: Knee varus deformity, 　High tibial osteotomy, 　Three-dimensional printing;　Arthroscopy

中图分类号:

R687.1

刘洋, 梁涛, 张磊, 刘刚, 易刚, 郭晓光, 周鑫, 扶世杰. 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[J]. 中国临床解剖学杂志, 2020, 38(1): 67-72.

LIU Yang, LIANG Tao, ZHANG Lei, LIU Gang, YI Gang, GUO Xiao-guang, ZHOU Xin, FU Shi-jie. Clinical analysis of a 3D-printing technique assisted with opening wedge high tibial osteotomy combined with arthroscopy in the treatment of knee varus deformity[J]. Chinese Journal of Clinical Anatomy, 2020, 38(1): 67-72.

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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

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

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