Department of Bone, Nanyang Central Hospital, Henan, China.
Department of Bone and Joint, Binzhou Medical University Hospital, Shandong, China.
BMC Musculoskelet Disord. 2024 Feb 9;25(1):126. doi: 10.1186/s12891-024-07234-2.
Evaluation of the accuracy and effectiveness of 3D printed guides to assist femoral tunnel preparation in individualised reconstruction of the anterior cruciate ligament.
Sixty patients who attended the Affiliated Hospital of Binzhou Medical College for autologous hamstring single bundle reconstruction of the anterior cruciate ligament from October 2018 to October 2020 were selected and randomly divided into two groups, including 31 cases in the 3D printing group (14 males and 17 females, mean age 41.94 ± 10.15 years) and 29 cases in the control group (13 males and 16 females, mean age 37.76 ± 10.34 years). Patients in both groups were assessed for intraoperative femoral tunnel accuracy, the number of intraoperative positioning and the time taken to prepare the femoral tunnel, the length of the anteromedial approach incision, the pre-planned bone tunnel length and intraoperative bone tunnel length in the 3D printed group, IKDC score and Lysholm score preoperatively and at 3, 6 and 12 months postoperatively, the Lachman、pivot-shift test preoperatively and at 6 months postoperatively, gait analysis to assess internal and external rotation in flexion of the knee at 12 months postoperatively and postoperative complications in both groups.
There was no statistical difference in functional knee scores and anteromedial approach incision length between the 3D printed and control groups (p > 0.05), while there was a statistical difference in the accuracy of tunnel positioning, the time taken to prepare the femoral bone tunnel and the degree of external rotation of the knee in flexion between the two groups (p < 0.05). There was no statistical difference between the preoperative planning of the bone tunnel length and the intraoperative bone tunnel length (p > 0.05).
One case in the 3D printing group developed intermuscular vein thrombosis in the affected lower limb after surgery, which disappeared after treatment, while three cases in the control group developed intermuscular vein thrombosis in the affected lower limb. No complications such as bone tunnel rupture, deep vein thrombosis in the lower limb and infection occurred in either group.
3D printed guides assisted with individualized ACL reconstruction may improve the accuracy of femoral tunnel positioning, which is safe and effective, while reducing the operative time and the number of intraoperative positioning, without increasing the length of incision, and may obtain higher functional scores and rotational stability of the knee joint, which is in line with the concept of individualized ACL reconstruction.
评估 3D 打印导板辅助个体化前交叉韧带重建中股骨隧道准备的准确性和有效性。
选择滨州医学院附属医院 2018 年 10 月至 2020 年 10 月收治的 60 例行自体腘绳肌腱单束重建前交叉韧带的患者，随机分为两组，其中 3D 打印组 31 例（男 14 例，女 17 例，平均年龄 41.94±10.15 岁），对照组 29 例（男 13 例，女 16 例，平均年龄 37.76±10.34 岁）。评估两组患者术中股骨隧道准确性、术中定位次数和股骨隧道准备时间、3D 打印组前内侧入路切口长度、术前计划骨隧道长度和术中骨隧道长度、术前和术后 3、6、12 个月的 IKDC 评分和 Lysholm 评分、术前和术后 6 个月的 Lachman、前抽屉试验、术后 12 个月膝关节屈膝时内外旋转步态分析以及两组术后并发症。
3D 打印组与对照组在膝关节功能评分和前内侧入路切口长度方面无统计学差异（p＞0.05），而在隧道定位准确性、股骨隧道准备时间和膝关节屈膝时外旋程度方面有统计学差异（p＜0.05）。术前计划骨隧道长度与术中骨隧道长度无统计学差异（p＞0.05）。
3D 打印组 1 例术后出现患侧下肢肌间静脉血栓形成，经治疗后消失，对照组 3 例术后出现患侧下肢肌间静脉血栓形成。两组均无骨隧道破裂、下肢深静脉血栓形成和感染等并发症。
3D 打印导板辅助个体化 ACL 重建可提高股骨隧道定位的准确性，安全有效，同时缩短手术时间和术中定位次数，不增加切口长度，并可能获得更高的膝关节功能评分和旋转稳定性，符合个体化 ACL 重建的理念。
