Department of Orthopedics, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
Department of Joint Reconstructive Surgery, Beijing Jishuitan Hospital, NO. 31 Xinjiekou East Street, Beijing, 100035, China.
J Orthop Surg Res. 2022 Mar 18;17(1):169. doi: 10.1186/s13018-022-03057-w.
Opening wedge high tibial osteotomy (OWHTO) is an effective surgical treatment for knee osteoarthritis. This study aimed to explore the feasibility and accuracy of a novel 3D-printed patient-specific instrument (PSI) based on "H-point" for medial OWHTO in a prospective cadaver study.
Twenty-six fresh-frozen lower limbs were collected and randomly divided into two groups: PSI group treated with 3D virtual preoperative planning and a novel 3D-printed PSI; control group with the standard technique. 3D models were reversely reconstructed for preoperative surgical planning, guide plate design, and simulated osteotomy. Anatomic features of "H-point," surgical time, fluoroscopic dose, correction accuracy including tibiofemoral angle (FTA) and posterior tibial slope (TS) angle were measured.
First, H-point was always described as a bony bulge in the posteromedial to the proximal tibia and had a relatively constant relationship with the osteotomy site. Second, the absolute correction error of mFTA and TS were significantly smaller in the PSI group. The effective rate of TS in the PSI group was more concentrated with absolute correction error within 1° and within 2° for 53.3% and 93.3%, compared to 9.1% and 45.5% in the control group. The total operation time, positioning osteotomy time, distraction correction time and fluoroscopy dose in the PSI group were significantly less than those in the control group.
The novel 3D-printed PSI based on H-point is feasibility and accuracy with advantages in terms of TS, surgery time and radiation dose for OWHTO.
开窗楔形胫骨高位截骨术（OWHTO）是治疗膝关节骨关节炎的有效手术治疗方法。本研究旨在探讨一种基于“H 点”的新型 3D 打印患者特异性器械（PSI）在前瞻性尸体研究中用于内侧 OWHTO 的可行性和准确性。
收集 26 个新鲜冷冻下肢并随机分为两组：PSI 组采用 3D 虚拟术前规划和新型 3D 打印 PSI 治疗；对照组采用标准技术。对 3D 模型进行反向重建，用于术前手术规划、导向板设计和模拟截骨。测量“H 点”解剖特征、手术时间、透视剂量以及校正准确性，包括胫股角（FTA）和后胫骨斜率（TS）角度。
首先，H 点始终被描述为胫骨近端后内侧的骨性隆起，并且与截骨部位具有相对恒定的关系。其次，PSI 组 mFTA 和 TS 的绝对校正误差明显较小。PSI 组 TS 的有效率更高，53.3%和 93.3%的绝对校正误差在 1°和 2°以内，而对照组分别为 9.1%和 45.5%。PSI 组的总手术时间、定位截骨时间、牵开矫正时间和透视剂量明显少于对照组。
基于 H 点的新型 3D 打印 PSI 在 OWHTO 中具有 TS、手术时间和辐射剂量方面的优势，具有可行性和准确性。
