Kim Hee-June, Park Jaeyeong, Park Kyeong-Hyeon, Park Il-Hyung, Jang Jin-An, Shin Ji-Yeon, Kyung Hee-Soo
Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea.
School of Mechanical Engineering, Yeungjin College, Daegu, Korea.
J Knee Surg. 2019 Sep;32(9):841-846. doi: 10.1055/s-0038-1669901. Epub 2018 Sep 6.
The purpose of this study was to evaluate the usefulness of a three-dimensional (3D) printed model for open-wedge high tibial osteotomy (HTO). This study retrospectively evaluated 20 patients with medial knee osteoarthritis and varus deformity. Between October 2015 and July 2016, the patients underwent open-wedge HTO using a 3D printed model. The mean age of patients was 55.2 years (range, 51-60 years). The mean preoperative mechanical femorotibial angle (mFTA) was varus 7.8 degrees (range, varus 4.7-11.6 degrees). After measuring the target angle using full-length lower limb weight-bearing radiography, the osteotomy was simulated using 3D images obtained from computed tomography (CT) with the 3D Slicer program. On the basis of the simulated osteotomy section and the target angle, the model was then designed and printed. Open-wedge HTO was then performed by applying the 3D printed model to the opening gap. The accuracy of osteotomy and the change in posterior tibial slope (PTS) angle were evaluated. The weight-bearing line on the tibial plateau was corrected from a preoperative mean of 19.5 ± 9.8% to a postoperative mean of 63.1 ± 6.1% ( < 0.001). The postoperative values were not statistically significantly different from the preoperative target points ( = 0.688). The mFTA was corrected to a postoperative mean of valgus 3.8 ± 1.4 degrees. The PTS angle showed no significant change ( = 0.256). A 3D printed model using CT may be useful for preoperative planning of open-wedge HTO. Satisfactory correction can be obtained without a change in the PTS.
本研究的目的是评估三维（3D）打印模型在开放性楔形高位胫骨截骨术（HTO）中的实用性。本研究回顾性评估了20例膝关节内侧骨关节炎和内翻畸形患者。在2015年10月至2016年7月期间，这些患者使用3D打印模型接受了开放性楔形HTO手术。患者的平均年龄为55.2岁（范围为51 - 60岁）。术前平均机械性股胫角（mFTA）为内翻7.8度（范围为内翻4.7 - 11.6度）。在使用全下肢负重X线摄影测量目标角度后，使用从计算机断层扫描（CT）获得的3D图像和3D Slicer程序模拟截骨术。根据模拟的截骨术截面和目标角度，然后设计并打印模型。然后通过将3D打印模型应用于开口间隙来进行开放性楔形HTO手术。评估了截骨术的准确性和胫骨后倾（PTS）角度的变化。胫骨平台上的负重线从术前平均19.5±9.8%校正到术后平均63.1±6.1%（<0.001）。术后值与术前目标点无统计学显著差异（=0.688）。mFTA校正后术后平均外翻3.8±1.4度。PTS角度无显著变化（=0.256）。使用CT的3D打印模型可能有助于开放性楔形HTO的术前规划。在不改变PTS的情况下可以获得满意的矫正效果。
