[1]孙振国,翁伟,李恒,等.3D打印技术辅助全膝关节置换术治疗骨关节炎膝外翻畸形的临床研究[J].中医正骨,2018,30(06):34-39.
　SUN Zhenguo,WENG Wei,LI Heng,et al.A clinical study of total knee arthroplasty assisted by 3D printing technology for treatment of valgus knee secondary to osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(06):34-39.
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3D打印技术辅助全膝关节置换术治疗骨关节炎膝外翻畸形的 临床研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第30卷
期数:
2018年06期
页码:
34-39
栏目:
临床研究
出版日期:
2018-06-20

文章信息/Info

Title:
A clinical study of total knee arthroplasty assisted by 3D printing technology for treatment of valgus knee secondary to osteoarthritis
作者:
孙振国; 翁伟; 李恒; 杨红航; 施利华
浙江省湖州市第一人民医院,浙江 湖州 313000
Author(s):
SUN Zhenguo; WENG Wei; LI Heng; YANG Honghang; SHI Lihua
The First People's Hospital of Huzhou,Huzhou 313000,Zhejiang,China
关键词:
骨关节炎;  膝外翻;  关节成形术; 置换; 膝;  3D打印
Keywords:
osteoarthritis;  genu valgum;  arthroplasty; replacement; knee;  three-dimensional printing
文献标志码:
A
摘要:
目的:观察3D打印技术辅助全膝关节置换术(total knee arthroplasty,TKA)治疗骨关节炎膝外翻畸形的临床疗效。方法:将32例骨关节炎膝外翻畸形患者随机分为3D打印技术辅助TKA组和单纯TKA组,每组16例。记录并比较2组患者手术时间、失血量,及术前和术后2周的膝关节活动范围、股胫角、美国特种外科医院(hospital for special surgery,HSS)膝关节评分及简明健康状况调查表(short form 36 health survey questionnaire,SF-36)评分。结果:3D打印技术辅助TKA组患者的手术时间短于单纯TKA组[(64.69±8.46)min,(72.31±5.44)min,t=3.033,P=0.005],失血量小于单纯TKA组[(448.13±48.20)mL,(495.00±49.13)mL,t=2.724,P=0.011]。术前2组患者膝关节活动范围比较,差异无统计学意义(71.06°±5.54°,72.63°±5.46°,t=0.803,P=0.428); 术后2周,2组患者膝关节活动范围均大于术前(116.63°±7.81°,71.06°±5.54°,t=19.024,P=0.000; 112.94°±8.38°,72.63°±5.46°,t=16.121,P=0.000); 2组患者膝关节活动范围比较,差异无统计学意义(t=1.288,P=0.208)。术前2组患者股胫角比较,差异无统计学意义(17.75°±6.02°,18.94°±6.71°,t=0.527,P=0.602); 术后2周,2组患者股胫角均小于术前(4.19°±1.11°,17.75°±6.02°,t=8.867,P=0.000; 5.38°±0.89°,18.94°±6.71°,t=8.018,P=0.000); 3D打印技术辅助TKA组股胫角小于单纯TKA组(t=3.348,P=0.002)。术前2组患者HSS膝关节评分比较,差异无统计学意义[(50.75±6.26)分,(51.25±5.73)分,t=0.236,P=0.815]; 术后2周,2组患者HSS膝关节评分均高于术前[(81.19±4.72)分,(50.75±6.26)分,t=15.534,P=0.000;(81.69±4.91)分,(51.25±5.73)分,t=16.131,P=0.000]; 2组患者HSS膝关节评分比较,差异无统计学意义(t=0.294,P=0.771)。术前2组患者SF-36评分比较,差异无统计学意义[(53.75±5.32)分,(52.88±5.25)分,t=0.468,P=0.643]; 术后2周,2组患者SF-36评分均高于术前[(80.00±3.74)分,(53.75±5.32)分,t=16.138,P=0.000;(78.50±4.40)分,(52.88±5.25)分,t=14.964,P=0.000]; 2组患者SF-36评分比较,差异无统计学意义(t=1.039,P=0.307)。结论:采用3D打印技术辅助TKA治疗骨关节炎膝外翻畸形,能改善膝关节活动范围,恢复下肢力线,促进膝关节功能恢复,提高患者生活质量; 且3D打印技术辅助TKA比单纯TKA手术时间短、失血量少、下肢力线恢复好,值得临床推广应用。
Abstract:
Objective:To observe the clinical curative effects of total knee arthroplasty(TKA)assisted by 3D printing technology in treatment of valgus knee secondary to knee osteoarthritis(KOA).Methods:Thirty-two patients with valgus knee secondary to KOA were randomly divided into 3D printing assisted TKA group and traditional TKA group,16 cases in each group.The operative time and intraoperative blood loss were recorded and compared between the 2 groups respectively.Moreover,the range of motion(ROM)of knee,femorotibial angle,hospital for special surgery(HSS)knee score and short form 36 health survey questionnaire(SF-36)score were measured and compared between the 2 groups before the surgery and at 2 weeks after the surgery respectively.Results:The operative time was shorter and the blood loss was less in 3D printing assisted TKA group compared to traditional TKA group(64.69+/-8.46 vs 72.31+/-5.44 min,t=3.033,P=0.005; 448.13+/-48.20 vs 495.00+/-49.13 mL,t=2.724,P=0.011).There was no statistical difference in ROM of knee between the 2 groups before the surgery(71.06+/-5.54 vs 72.63+/-5.46 degrees,t=0.803,P=0.428).The ROM of knee increased in both of the 2 groups at 2 weeks after the surgery compared to pre-surgery(116.63+/-7.81 vs 71.06+/-5.54 degrees,t=19.024,P=0.000; 112.94+/-8.38 vs 72.63+/-5.46 degrees,t=16.121,P=0.000),and there was no statistical difference in ROM of knee between the 2 groups(t=1.288,P=0.208).There was no statistical difference in femorotibial angles between the 2 groups before the surgery(17.75+/-6.02 vs 18.94+/-6.71 degrees,t=0.527,P=0.602).The femorotibial angles decreased in both of the 2 groups at 2 weeks after the surgery compared to pre-surgery(4.19+/-1.11 vs 17.75+/-6.02 degrees,t=8.867,P=0.000; 5.38+/-0.89 vs 18.94+/-6.71 degrees,t=8.018,P=0.000),and the femorotibial angles were smaller in 3D printing assisted TKA group compared to traditional TKA group(t=3.348,P=0.002).There was no statistical difference in HSS knee scores between the 2 groups before the surgery(50.75+/-6.26 vs 51.25+/-5.73 points,t=0.236,P=0.815).The HSS knee scores increased in both of the 2 groups at 2 weeks after the surgery compared to pre-surgery(81.19+/-4.72 vs 50.75+/-6.26 points,t=15.534,P=0.000; 81.69+/-4.91 vs 51.25+/-5.73 points,t=16.131,P=0.000),and there was no statistical difference in HSS knee scores between the 2 groups(t=0.294,P=0.771).There was no statistical difference in SF-36 scores between the 2 groups before the surgery(53.75+/-5.32 vs 52.88+/-5.25 points,t=0.468,P=0.643).The SF-36 scores increased in both of the 2 groups at 2 weeks after the surgery compared to pre-surgery(80.00+/-3.74 vs 53.75+/-5.32 points,t=16.138,P=0.000; 78.50+/-4.40 vs 52.88+/-5.25 points,t=14.964,P=0.000),and there was no statistical difference in SF-36 scores between the 2 groups(t=1.039,P=0.307).Conclusion:The 3D printing technology assisted TKA can improve knee ROM,restore lower limb force-lines,promote knee functional recovery and improve patient's life quality in treatment of valgus knee secondary to KOA.Moreover,the 3D printing technology assisted TKA has the advantages of shorter operative time,less blood loss and better lower limb force-lines compared to traditional TKA,so it is worthy of popularizing in clinic.

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更新日期/Last Update: 2018-10-30