| 3D打印个性化截骨导板在膝关节置换术中精准重建下肢力线的临床疗效 |
| Clinical efficacy of 3D-printed personalized osteotomy guides in accurate reconstruction of lower limb mechanical alignment during total knee arthroplasty |
| 投稿时间：2025-05-23 |
| DOI：10.3969/j.issn.1672-5972.2026.04.009 |
| 中文关键词: 3D打印 截骨导板 膝关节骨关节炎 人工全膝关节置换术 髌骨轨迹 下肢力线 股骨旋转对线 |
| 英文关键词:3D printing Osteotomy guide plate Knee osteoarthritis Total knee arthroplasty Patellar tracking Lower limb alignment Femoral rotational alignment |
| 基金项目:新疆维吾尔自治区人民医院精准医学项目（20220305） |
| 作者 | 单位 | 邮编 | | 韩衍龙* | 新疆维吾尔自治区人民医院骨科中心关节外科,新疆 乌鲁木齐,830000 | 830000 | | 米安民 | 新疆维吾尔自治区人民医院骨科中心关节外科,新疆 乌鲁木齐,830000 | 830000 | | 叶子昂 | 新疆维吾尔自治区人民医院骨科中心关节外科,新疆 乌鲁木齐,830000 | 830000 | | 赵巍 | 新疆维吾尔自治区人民医院骨科中心关节外科,新疆 乌鲁木齐,830000 | 830000 | | 哈巴西·卡肯 | 新疆维吾尔自治区人民医院骨科中心关节外科,新疆 乌鲁木齐,830000 | 830000 | | 王利* | 新疆维吾尔自治区人民医院骨科中心关节外科,新疆 乌鲁木齐,830000 | 830000 |
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| 中文摘要: |
| 目的 探讨人工全膝关节置换术（total knee arthroplasty, TKA）中采用3D打印个性化导板辅助精确定位股骨旋转对线、髌骨轨迹和术后重建下肢力线的效果。方法 回顾性选择新疆维吾尔自治区人民医院骨科中心关节外科2023年1月至2024年3月接受TKA治疗且符合纳入标准的60例膝关节骨关节炎患者作为研究对象。其中，30例接受3D打印个性化截骨导板辅助TKA治疗（3D导板组）；30例接受常规TKA治疗（传统组）。对两组患者围手术期指标（手术时间、术中失血量）进行对比分析，系统评估术前术后影像学参数变化，如股骨后髁角（PCA）、髌骨横轴-股骨通髁线角（PFA）、髋膝踝角（HKA），以及功能评分改善情况（美国膝关节协会AKS评分、美国特种外科医院HSS评分），并记录术后不良事件发生情况。结果 所有研究对象均完成TKA，术后随访5～7个月，平均（6.41±0.82）个月，围手术期未出现重大并发症。统计学分析显示：3D导板组术后3 d的HKA角（179.43°±0.27°）较传统组（178.49°±0.50°）更接近生理中立位（P＜0.05）；3D导板组术后3 d的PCA角（0.45°±0.58°）与PFA角（0.46°±0.55°）均显著低于传统组（0.97°±0.24°与1.00°±0.27°，P＜0.05）；此外，3D导板组术后6个月的HSS评分（92.43±2.53）与AKS评分（91.57±2.66）也优于传统组（87.93±2.06与89.73±2.00，P＜0.05）。结论 3D打印个性化导板辅助TKA较传统TKA更精准、安全，能更精准重建下肢力线，且能使患者获得更优的早期功能恢复，有一定的临床应用价值。 |
| 英文摘要: |
| Objective To investigate the effectiveness of using 3D-printed personalized guides in total knee arthroplasty (TKA) for achieving precise positioning of femoral rotational alignment, optimizing patellar tracking, and reconstructing postoperative lower limb mechanical alignment.Methods A retrospective study was conducted on 60 knee osteoarthritis patients who underwent TKA at department of joint surgery and orthopedic center, People's Hospital of Xinjiang Uygur Autonomous Region between January 2023 and March 2024, meeting inclusion criteria. The cohort comprised two groups: 30 patients receiving 3D-printed personalized osteotomy guide-assisted TKA (3D guide group) and 30 patients undergoing conventional TKA (conventional group). Comparative analyses were performed on baseline characteristics (age, gender, surgical side) and perioperative indicators (operative time, intraoperative blood loss). Systematic evaluations included radiographic parameter changes, such as posterior condylar angle (PCA), patellar transverse axis-femoral transepicondylar line angle (PFA), hip-knee-ankle angle (HKA), and functional score improvements, such as American Knee Society Score(AKS), Hospital for Special Surgery Score(HSS) pre- and postoperatively. Postoperative adverse events were documented.Results All procedures were successfully completed. The mean follow-up was (6.41±0.82) months (range: 5-7 months), with no major perioperative complications. Statistical analysis revealed that the postoperative HKA angle in the 3D-PSI group (179.43°±0.27°) was significantly closer to the neutral mechanical axis compared to the conventional group (178.49°±0.50°) (P<0.05). Furthermore, the 3D-PSI group exhibited significantly lower postoperative PCA (0.45°±0.58°) and PFA angles (0.46°±0.55°) than the conventional group (0.97°±0.24° and 1.00°±0.27°, respectively) (P<0.05). Additionally, at the 6-month follow-up, the 3D-PSI group demonstrated superior HSS (92.43±2.53) and AKS scores (91.57±2.66) compared to the conventional group (87.93±2.06 and 89.73±2.00) (P<0.001).Conclusion Compared to conventional TKA, TKA assisted by 3D-printed patient-specific guides provides more accurate reconstruction of lower limb mechanical alignment and leads to better early functional recovery, demonstrating significant clinical application value. |
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