Effectiveness of total knee arthroplasty using three-dimensional printing technology for knee osteoarthritis accompanied with extra-articular deformity
- 医学院－已发表论文 
目的探讨3D打印技术辅助人工全膝关节置换术(total knee arthroplasty,TKA)治疗合并关节外畸形的膝骨关节炎(knee; osteoarthritis,KOA)的临床疗效。方法2013年3月2015年12月,收治15例(18膝)合并关节外畸形的KOA患者。男6例(6; 膝),女9例(12膝);年龄55~70岁,平均60.2岁;病程7~15年,平均10.8年。单膝12例,双膝3例。膝关节学会评分系统(KSS)临床; 评分为(57.441.06)分,功能评分为(60.881.26)分。膝关节活动度为(72.220.18)°。下肢力线偏移(18.890.92)°; 。合并股骨侧畸形8例(10膝),胫骨侧畸形5例(5膝),股骨侧及胫骨侧畸形2例(3膝)。术前3D打印骨骼模型、截骨导航模板并设计手术方案,选择合; 适的膝关节假体后实施TKA。结果手术时间65~100 min,平均75.6 min;术中出血量50~150 mL,平均90.2; mL。术后均未出现切口愈合不良、感染、血栓等并发症。患者均获随访,随访时间12~30个月,平均22个月。末次随访时,X线片示假体位置均良好,未发; 现松动、下沉;下肢力线偏移(2.000.29)°,与术前比较差异有统计学意义(t=13.120,P=0.007);KSS临床评分为(87.500; .88)分、功能评分为(81.941.41)分,与术前比较差异有统计学意义(t=27.553,P=0.000;t=35.551,P=0.000); ;膝关节活动度为(101.941.42)°,与术前比较差异有统计学意义(t=31.633,P=0.000)。结论对于合并关节外畸形的KOA,采用; 3D打印技术辅助TKA,可达到个体化治疗、降低手术难度,有效矫正畸形,恢复患者膝关节功能的目的。Objective To evaluate the effectiveness of total knee arthroplasty (TKA); using three-dimensional (3D) printing technology for knee osteoarthritis; (KOA) accompanied with extra-articular deformity. Methods Between March; 2013 and December 2015, 15 patients (18 knees) with extra-articular; deformity and KOA underwent TKA. There were 6 males (6 knees) and 9; females (12 knees), aged 55-70 years (mean, 60.2 years). The mean; disease duration was 10.8 years (range, 7-15 years). The unilateral knee; was involved in 12 cases and bilateral knees in 3 cases. The clinical; score was 57.441.06 and the functional score was 60.881.26 of Knee; Society Score (KSS). The range of motion of the knee joint was; (72.220.18)°. The deviation of mechanical axis of lower limb was; (18.890.92)° preoperatively. There were 8 cases (10 knees) with; extra-articular femoral deformity, 5 cases (5 knees) with; extra-articular tibial deformity, and 2 cases (3 knees) with; extra-articular femoral and tibial deformities. Bone models and the; navigation templates were printed and the operation plans were designed; using 3D printing technology. The right knee joint prostheses were; chosen. Results The operation time was 65-100 minutes (mean, 75.6; minutes). The bleeding volume was 50-150 mL (mean, 90.2 mL). There was; no poor incision healing, infection, or deep venous thrombosis after; operation. All patients were followed up 12- 30 months (mean, 22; months). Prostheses were located in the right place, and no sign of; loosening or subsidence was observed by X-ray examination. At last; follow-up, the deviation of mechanical axis of lower limb was; (2.000.29)°, showing significant difference when compared with; preoperative one (t=13.120, P=0.007). The KSS clinical score was; 87.500.88 and function score was 81.941.41, showing significant; differences when compared with preoperative ones (t=27.553, P=0.000;; t=35.551, P=0.000). The range of motion of knee was (101.941.42)°,; showing significant difference when compared with preoperative one; (t=31.633, P=0.000). Conclusion For KOA accompanied with extra-articular; deformity, TKA using 3D printing technology has advantages such as; individualized treatment, reducing the difficulty of operation, and; achieving the satisfactory function.