个性化截骨导板辅助TKA治疗膝骨性关节炎并关节外畸形Patient specific instrumentation assisted primary knee replacement for knee osteoarthritis accompanied with extra-articular deformity
骆晓飞;宋树春;魏瑄;王少华;王金良;李哲;
摘要(Abstract):
[目的]介绍个性化截骨导板辅助一期全膝关节置换治疗膝关节骨性关节炎合并关节外畸形的技术与初步临床结果。[方法] 2013年3月~2018年6月采用个性化截骨导板辅助全膝关节置换一期手术治疗膝关节骨性关节炎合并关节外畸形患者31例。术前对全下肢行薄层(0.5 mm) CT扫描,重建下肢全长3D影像,设计出截骨平面和截骨厚度,预测假体型号,3-D打印出尼龙材料个体化截骨导板备用。术中在个体化截骨导板引导下进行截骨,安装假体。[结果] 31例患者均顺利完成手术,术中无严重并发症。术后随访12~63个月,平均(37.35±2.61)个月。ROM由术前(83.26±4.13)°增加至末次随访时(97.22±7.81)°。HSS评分从(54.88±6.16)分提高到(85.39±8.93)分。VAS评分由术前(6.86±0.53)分下降至(2.15±0.34)分。影像方面,31例患者冠状位下肢机械轴偏移角度由术前(16.17±5.73)°纠正至(2.93±0.58)°。未见假体松动等不良征象。[结论]在个性化截骨导板辅助下,通过关节内代偿截骨结合软组织平衡技术一期完成全膝关节置换,能够很好恢复下肢机械轴线,获得满意的疗效。
关键词(KeyWords): 全膝关节置换;膝关节骨性关节炎;关节外畸形;患者特异性工具
基金项目(Foundation):
作者(Author): 骆晓飞;宋树春;魏瑄;王少华;王金良;李哲;
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参考文献(References):
- [1]Lonner JH,Siliski JM,Lotke PA.Simultaneous femoral osteotomy and total knee arthroplasty for treatment of osteoarthritis associated with severe extra-articular deformity[J].J Bone Joint Surg Am2000,82:342-348.
- [2]张晓岗,任姜栋,曹力,等.一期全膝关节置换术治疗膝关节炎合并关节外畸形[J].中华骨科杂志,2011,31(8):846-851.
- [3]Oswald MH,Jakob RP,Schneider E,et al.Radiological analysis of normal axial alignment of femur and tibia in view of total knee arthroplasty[J].J Arthroplasty,1993,8:419-426.
- [4]刘浩,吴博,郑清源,等.个性化股骨远端截骨导向器与传统手术工具在全膝关节置换术中的对比研究[J].中华骨科杂志,2018,38(19):1170-1176.
- [5]马军,牛东生,尚小可,等.全膝关节置换治疗严重膝外翻畸形的临床研究[J].中国矫形外科杂志,2011,19(11):897-899.
- [6]许志庆,王武炼,庄至坤,等.3D打印技术辅助人工全膝关节置换术治疗合并关节外畸形的膝骨关节炎[J].中国修复重建外科杂志,2017,31(8):913-917.
- [7]Paredes Carneroa X,Escobarb J,Galdoc JM,et al.Total knee arthroplasty for treatment of osteoarthritis associated with extra-articular deformity[J].J Clin Orthop Trauma,2018,9:125-132.
- [8]Gokulakrishnan PP,Balaji U,Ashraf MM.Total knee arthroplasty in patients with extra-articular deformity:a critical analysis[J].Int J Orthop Sci,2018,4(1):18-22.
- [9]Bae DK,Song SJ,Park CH,et al.A comparison of the mediumterm results of total knee arthroplasty using computer-assisted and conventional techniques to treat patients with extraarticular femoral deformities[J].J Arthroplasty,2017(32):71-78.
- [10]任江涛,徐丛,王建松,等.三维打印个性化导板与传统截骨工具在全膝关节置换术中疗效比较的Meta分析[J].中华外科杂志,2017,55(10):775-781.
- [11]Anderl W,Pauzenberger L,Kololinger R,et a1.Erratum to:Patient-specific instrumentation improved mechanical alignment,while early clinical outcome was comparable to conventionalinstrumentation in TKA[J].Knee Surg Sports Traumatol Arthrosc,2016,24(12):4013.
- [12]张凤军,李新花,王强,等.个体化截骨导板辅助股骨关节外畸形全膝置换术[J].中国矫形外科杂志,2018,26(15):1423-1426.
- [13]梁宇鹏,田华.个性化截骨工具用于全膝关节置换术的研究进展[J].中华医学杂志,2019,99(1):75-78.
- [14]Abane L,Zaoui A,Anract P,et al.Can a single-use and patientspecific instrumentation be reliably used in primary total knee arthroplasty?a multicenter controlled study[J].The Journal of Arthroplasty,2018,(33):2111-2118.
- [15]Saibaba B,Dhillon MS,Chouhan DK,et al.Significant incidence of extra-articular tibia vara affects radiological outcome of total knee arthroplasty[J].Knee Surg Relat Res,2015,27:173-180.
- [16]Matthew AP,Matthieu O,Sebastien P,et al.Effect of postoperative mechanical axis alignment on survival and functional outcomes of modern total knee arthroplasties with cement:a concise follow-up at 20 years[J].J Bone Joint Surg Am,2018,100(6):472-478.2019-09-30 2019-11-08