【摘要】：目的探討3D打印技術(shù)輔助人工全膝關(guān)節(jié)置換術(shù)(total knee arthroplasty,TKA)治療合并關(guān)節(jié)外畸形的膝骨關(guān)節(jié)炎(knee osteoarthritis,KOA)的臨床療效。方法 2013年3月—2015年12月,收治15例(18膝)合并關(guān)節(jié)外畸形的KOA患者。男6例(6膝),女9例(12膝);年齡55~70歲,平均60.2歲;病程7~15年,平均10.8年。單膝12例,雙膝3例。膝關(guān)節(jié)學(xué)會(huì)評(píng)分系統(tǒng)(KSS)臨床評(píng)分為(57.44±1.06)分,功能評(píng)分為(60.88±1.26)分。膝關(guān)節(jié)活動(dòng)度為(72.22±0.18)°。下肢力線偏移(18.89±0.92)°。合并股骨側(cè)畸形8例(10膝),脛骨側(cè)畸形5例(5膝),股骨側(cè)及脛骨側(cè)畸形2例(3膝)。術(shù)前3D打印骨骼模型、截骨導(dǎo)航模板并設(shè)計(jì)手術(shù)方案,選擇合適的膝關(guān)節(jié)假體后實(shí)施TKA。結(jié)果手術(shù)時(shí)間65~100 min,平均75.6 min;術(shù)中出血量50~150 m L,平均90.2 m L。術(shù)后均未出現(xiàn)切口愈合不良、感染、血栓等并發(fā)癥。患者均獲隨訪,隨訪時(shí)間12~30個(gè)月,平均22個(gè)月。末次隨訪時(shí),X線片示假體位置均良好,未發(fā)現(xiàn)松動(dòng)、下沉;下肢力線偏移(2.00±0.29)°,與術(shù)前比較差異有統(tǒng)計(jì)學(xué)意義(t=13.120,P=0.007);KSS臨床評(píng)分為(87.50±0.88)分、功能評(píng)分為(81.94±1.41)分,與術(shù)前比較差異有統(tǒng)計(jì)學(xué)意義(t=27.553,P=0.000;t=35.551,P=0.000);膝關(guān)節(jié)活動(dòng)度為(101.94±1.42)°,與術(shù)前比較差異有統(tǒng)計(jì)學(xué)意義(t=31.633,P=0.000)。結(jié)論對(duì)于合并關(guān)節(jié)外畸形的KOA,采用3D打印技術(shù)輔助TKA,可達(dá)到個(gè)體化治療、降低手術(shù)難度,有效矯正畸形,恢復(fù)患者膝關(guān)節(jié)功能的目的。
[Abstract]:Objective to investigate the clinical effect of 3 D printing assisted total knee arthroplasty (total knee arthroplasty,TKA) in the treatment of knee osteoarthritis (knee osteoarthritis,KOA) with extraarticular deformity. Methods from March 2013 to December 2015, 15 KOA patients (18 knees) with extraarticular malformation were treated. Male 6 cases (6 knees), female 9 cases (12 knees), age 5570 years, mean 60.2 years, course of disease 7 ~ 15 years, mean 10.8 years. There were 12 cases with single knee and 3 cases with double knee. The (KSS) clinical score and the functional score were (57.44 鹵1.06) and (60.88 鹵1.26) respectively. The range of knee motion was (72.22 鹵0.18) 擄. The lower limb force line deviation was (18.89 鹵0.92) 擄. 8 cases (10 knees) were associated with femoral side malformation, 5 cases (5 knees) were tibial side deformities, 2 cases (3 knees) were femoral and tibial side deformities. Preoperative 3D printing of bone model, osteotomy navigation template and design of surgical procedures, selection of appropriate knee prosthesis after the implementation of TKA. Results the operative time was 65 ~ 100 min, and the average blood loss was 75. 6 min;. The average blood loss was 90. 2 mL. There were no complications such as poor wound healing, infection, thrombus and so on. All patients were followed up for 12 ~ 30 months (mean 22 months). At the last follow-up, the position of the prosthesis was good, no loosening and sinking were found, the force line deviation of lower extremity was (2.00 鹵0.29) 擄, which was significantly different from that before operation (t _ (13.120) P _ (0.007). The clinical score of KSS was (87.50 鹵0.88), and the score of function was (81.94 鹵1.41), which was significantly different from that before operation (t = 27.553). The range of motion of knee joint was (101.94 鹵1.42) 擄, which was significantly different from that before operation (t = 31.633P = 0.000). Conclusion for KOA, with extraarticular malformation, 3D printing technique can be used to assist TKA, to achieve individualized treatment, to reduce the difficulty of operation, to correct deformity effectively and to recover the function of knee joint.
【作者單位】： 福建中醫(yī)藥大學(xué)附屬泉州市正骨醫(yī)院關(guān)節(jié)外科;廈門大學(xué)附屬福州市第二醫(yī)院關(guān)節(jié)外科;
【分類號(hào)】：R687.4

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本文編號(hào)：2304893