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Title: [Effectiveness of distal femoral osteotomy assisted by three-dimensional printing technology for correction of valgus knee with osteoarthritis].
Author: Chen G, Li G, Lin Z, Chen X, Zhang G, You F, Chen J, Zeng Q, Zheng F, Yu Z.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2017 Feb 15; 31(2):134-138. PubMed ID: 29786241.
Abstract:
OBJECTIVE: To evaluate the effectiveness of distal femoral osteotomy aided by three-dimensional (3D) printing cutting block for correction of vaglus knee with osteoarthritis. METHODS: Between January 2014 and January 2016, 12 patients (15 knees) with vaglus deformity and lateral osteoarhritis underwent medial closing wedge distal femoral osteotomy. There were 5 males and 7 females, aged 30-60 years (mean, 43.8 years). The mean disease duration was 6.6 years (range, 1-12 years). The unilateral knee was involved in 9 cases and bilateral knees in 3 cases. According to Koshino's staging system, 1 knee was classified as stage I, 9 knees as stage II, and 5 knees as stage III. The X-ray films of bilateral lower extremities showed that the femorotibial angle (FTA) and anatomical lateral distal femoral angle (aLDFA) were (160.40±2.69)° and (64.20±2.11)° respectively. Mimics software was used to design and print the cutting block by 3D printing technique. During operation, the best location of distal femoral osteotomy was determined according to the cutting block. After osteotomy, internal fixation was performed using a steel plate and screws. RESULTS: All incisions healed primarily; no complication of infection or deep vein thrombosis was observed. All patients were followed up 6-18 month (mean, 12.2 months). At 6 months after operation, the hospital for special surgery (HSS) score for knee was significantly improved to 89.07±2.49 when compared with preoperative score (65.27±1.49, t=-28.31, P=0.00); the results were excellent in 10 knees, good in 4 knees, and fair in 1 knee with an excellent and good rate of 93.3%. The bony union time was 2.9-4.8 months (mean, 3.3 months). Bone delayed union occurred in 1 case (1 knee). The postoperative FTA and aLDFA were (174.00±1.41)° and (81.87±1.06)° respectively, showing significant differences when compared with preoperative ones ( t=-18.26， P=0.00; t=-25.19, P=0.00). The percentage of medial tibial plateau in whole tibial plateau was 49.78%±0.59%, showing no significant difference when compared with intraoperative measurement (49.82%±0.77%, t=0.14, P=0.89). CONCLUSION: 3D printing cutting block can greatly improve the accuracy of distal femoral osteotomy, and ensure better effectiveness for correction of vaglus knee with osteoarthritis. 目的: 探讨 3D 打印技术辅助股骨远端截骨术（distal femoral osteotomy，DFO）治疗膝外翻畸形骨关节炎的临床疗效。. 方法: 2014 年 1 月—2016 年 1 月，收治膝外翻畸形骨关节炎患者 12 例（15 膝）。男 5 例，女 7 例；年龄 30～60 岁，平均 43.8 岁。病程 1～12 年，平均 6.6 年。单膝 9 例，双膝 3 例。骨关节炎 Koshino 分级：Ⅰ级 1 例（1 膝），Ⅱ级 7 例（9 膝），Ⅲ级 4 例（5 膝）。摄双下肢全长 X 线片，测量股胫角（femorotibial angle，FTA）为（160.40±2.69）°，远端股骨外侧角（anatomical lateral distal femoral angle，aLDFA）为（64.20±2.11）°。术前于 Mimics 软件设计截骨模块并 3D 打印，术中通过截骨模块确定最佳截骨方位进行截骨，最后行钢板及螺钉内固定。. 结果: 术后切口均Ⅰ期愈合，无感染、下肢深静脉血栓形成等并发症发生。患者均获随访，随访时间 6～18 个月，平均 12.2 个月。术后 6 个月膝关节 HSS 评分为（89.07±2.49）分，较术前（65.27±1.49）分显著提高（ t=–28.31， P=0.00）；获优 10 膝、良 4 膝、可 1 膝，优良率为 93.3%。X 线片复查示，患者截骨处均达骨性愈合，愈合时间 2.9～4.8 个月，平均 3.3 个月；1 例（1 膝）出现骨延迟愈合。术后 6 个月测量 FTA 为（174.00±1.41）°，aLDFA 为（81.87±1.06）°，与术前比较差异均有统计学意义（ t=–18.26， P=0.00； t=–25.19， P=0.00）；下肢力线位置测量显示内侧胫骨平台占整个胫骨平台百分比为 49.78%±0.59%，与术中测量的 49.82%±0.77%比较，差异无统计学意义（ t=0.14， P=0.89）。. 结论: DFO 治疗膝外翻畸形骨关节炎时，3D 打印截骨模块可辅助术中股骨远端精确截骨，获得满意临床疗效。.

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