Department of Sports Medicine, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, China.
Sichuan International Expo Group, Chengdu, China.
Biomed Res Int. 2020 Nov 15;2020:1923172. doi: 10.1155/2020/1923172. eCollection 2020.
The purpose of this study was to compare the accuracy and clinical outcomes of the medial open wedge high tibial osteotomy (MOWHTO) using a three-dimensional (3D-) printed patient-specific instrumentation (PSI) with that of conventional surgical techniques.
A prospective comparative study which included 18 patients who underwent MOWHTO using 3D-printed PSI technique (3D-printed group) and 19 patients with conventional technique was conducted from Jan 2019 to Dec 2019. After the preoperative planning, 3D-printed PSI (cutting guide model) was used in MOWHTO for 3D-printed group, while freehand osteotomies were adopted in the conventional group. The accuracy of MOWHTO for each method was compared using the radiological index obtained preoperatively and postoperatively, including mechanical femorotibial angle (mFTA) and medial mechanical proximal tibial angle (mMPTA), and correction error. Regular clinical outcomes were also compared between the 2 groups.
The correction errors in the 3D-printed group were significantly lower than the conventional group (mFTA, 0.2° ± 0.6° vs. 1.2° ± 1.4°, = 0.004) (mMPTA, 0.1° ± 0.4° vs. 2.2° ± 1.8°, < 0.00001). There was a significantly shorter duration ( < 0.00001) and lower radiation exposures ( < 0.00001) for the osteotomy procedure in the 3D-printed group than in the conventional group. There were significantly higher subjective IKDC scores ( = 0.009) and Lysholm scores ( = 0.03) in the 3D-printed group at the 3-month follow-up, but not significantly different at other time points. Fewer complications occurred in the 3D-printed group.
With the assistance of the 3D-printed patient-specific cutting guide model, a safe and feasible MOWHTO can be conducted with superior accuracy than the conventional technique.
本研究旨在比较使用三维（3D）打印患者特异性器械（PSI）的内侧开放楔形胫骨高位截骨术（MOWHTO）与传统手术技术的准确性和临床结果。
本研究为前瞻性对照研究，纳入 2019 年 1 月至 2019 年 12 月期间行 MOWHTO 的 18 例患者（3D 打印组）和 19 例采用传统技术的患者。术前规划后，3D 打印组采用 MOWHTO 的 3D 打印 PSI（截骨导板模型），而传统组采用徒手截骨。比较两种方法的 MOWHTO 准确性，使用术前和术后获得的影像学指标，包括机械股胫角（mFTA）和内侧机械胫骨近端角（mMPTA）以及校正误差。还比较了两组的常规临床结果。
3D 打印组的校正误差明显低于传统组（mFTA，0.2°±0.6°对 1.2°±1.4°， = 0.004）（mMPTA，0.1°±0.4°对 2.2°±1.8°， < 0.00001）。3D 打印组截骨术的手术时间明显更短（ < 0.00001），射线暴露量明显更低（ < 0.00001）。3D 打印组在 3 个月随访时的主观 IKDC 评分（ = 0.009）和 Lysholm 评分（ = 0.03）明显更高，但在其他时间点无明显差异。3D 打印组并发症发生率较低。
在 3D 打印患者特异性截骨导板模型的辅助下，与传统技术相比，MOWHTO 可以更安全、更精确地进行。
