关节腔内3D打印导板在前交叉韧带重建股骨侧定位中的应用

Intra-articular application of 3-D printed guides for femoral positioning in anterior cruciate ligament reconstruction

摘要:

目的 探讨基于改良象限法结合患者影像学数据设计的3D打印股骨定位器，辅助前交叉韧带（ACL）股骨侧定位重建的应用效果。方法 选取2023年1月－2024年1月该院收治的ACL初次断裂的患者60例，随机分为3D打印导板组（使用3D打印股骨定位导板辅助ACL重建，导板为尼龙材质）和传统手术组（采用传统手术，术中直视ACL重建），每组30例。两组患者术前和术后行膝关节CT和三维重建。以改良象限法分析比较组内和组间患者术前和术后股骨隧道中心点坐标百分率（Fx和Fy）。结果 3D打印导板组手术时间为（53.8±6.0）min，明显短于传统手术组的（62.4±7.8）min，差异有统计学意义（P < 0.05）。使用改良象限法分析，3D打印导板组股骨隧道中心的术后相对坐标位置百分率为（28.4±2.0）%和（35.5±2.3）%，与术前规划的（28.4±0.0）%和（35.7±0.0）%比较，差异均无统计学意义（P > 0.05）；传统手术组术后相对坐标位置百分率为（28.1±2.9）%和（35.2±3.2）%，与术前规划的（28.4±0.0）%和（35.7±0.0）%比较，差异均无统计学意义（P > 0.05）；两组患者术后股骨隧道中心位置坐标百分率组间比较，差异无统计学意义（P > 0.05）。两组患者术后Lysholm评分和国际膝关节评分委员会（IKDC）评分呈递增趋势，各时点Lysholm评分和IKDC评分组内比较，差异均有统计学意义（P < 0.05），但组间比较，差异均无统计学意义（P > 0.05）。结论 采用关节腔内3D打印导板技术辅助和传统手术行ACL重建股骨侧定位，均可实现解剖重建，两者骨隧道位置无明显差异。然而，采用关节腔内3D打印导板技术，股骨隧道中心点分布更加集中，手术时间更短，可为临床ACL重建过程中创建患者股骨隧道个性化定位器提供参考。

Abstract:

Objective To investigate the application of a 3-D printed femoral locator designed based on the modified quadrant method, combined with patient imaging data, then assist in femoral positioning for anterior cruciate ligament (ACL) reconstruction.Methods From January 2023 to January 2024, 60 patients with primary ACL rupture who met the inclusion criteria were randomly assigned to either the 3-D printed guide group (using a 3-D printed femoral positioning guide to assist ACL reconstruction with nylon material) or the traditional surgery group (traditional surgery with direct visualization ACL reconstruction), with 30 patients in each group. Preoperative and postoperative knee CT scans and three-dimensional reconstructions were performed. The modified quadrant method was used to analyze and compare the percentage coordinates (Fx and Fy) of the femoral tunnel center point pre- and postoperatively within the same group and between different groups.Results The guides were made using nylon material. The surgery duration was significantly shorter in the 3D-printed guide group (53.8 ± 6.0) min compared to the traditional surgery group (62.4 ± 7.8) min, the difference was statistically significant (P < 0.05). Analysis using the modified quadrant method showed that the postoperative relative coordinate position percentages of the femoral tunnel center in the 3D-printed guide group (28.4 ± 2.0)% and (35.5 ± 2.3)% were not significantly different from the preoperative planned values (28.4 ± 0.0)% and (35.7 ± 0.0)%, the differences were not statistically significant (P > 0.05). Similarly, in the traditional surgery group, the postoperative coordinate percentages (28.1 ± 2.9）% and (35.2 ± 3.2)% showed no significant difference compared to the preoperative planned values (28.4 ± 0.0)% and (35.7 ± 0.0)%, the differences were not statistically significant (P > 0.05). There was no statistically significant difference in the postoperative femoral tunnel center position percentages between the two groups (P > 0.05). The Lysholm score and International Knee Documentation Committee (IKDC) score of the two groups showed an increasing trend after surgery, and the differences between Lysholm score and IKDC score at each time point were statistically significant (P < 0.05). However, no statistical differences were found between the two groups at each postoperative time point (P > 0.05).Conclusion Both intra-articular 3D-printed guide-assisted and traditional surgery-assisted femoral positioning for ACL reconstruction can achieve anatomical reconstruction, with no significant difference in bone tunnel positioning. However, the use of intra-articular 3D-printed guide technology has a more centralized distribution of the femoral tunnel center point and a shorter surgery duration. This study provides proof of concept for the creation of personalized femoral tunnel locators for patients undergoing ACL reconstruction.