目的:据报道,使用合成骨替代材料(BSM)作为截骨间隙填充物可改善内侧开口楔形胫骨高位截骨术(MOWHTO)的疗效。这项研究旨在评估新型患者特异性3D打印蜂窝状结构聚己内酯和磷酸三钙(PCL-TCP)合成移植物与同种异体骨移植物作为截骨间隙填充物的早期放射学结果(骨愈合)和并发症发生率。
方法:对接受PCL-TCP合成移植或同种异体股骨头移植作为截骨间隙填充物的MOWHTO患者进行回顾性配对分析。截骨间隙被分成相等的区域(1-5区),在术后1,3,6和12个月根据vanHemert分类在前后X线片上评估骨愈合。术后并发症,包括感染,外侧铰链骨折,并测量持续性疼痛。研究组与对照组进行年龄匹配,吸烟状况,糖尿病,和截骨间隙大小。
结果:在1个月时,PCL-TCP组的骨愈合进展明显大于同种异体移植组(1-3区),3个月(1-4区),6个月(1-2、4区),术后12个月(2-3、5区)(P<0.05)。在1年时,两组之间的并发症发生率没有显着差异。
结论:术后1年,在使用PCL-TCP合成移植物截骨间隙填充物的MOWHTO患者中观察到的骨愈合率优于同种异体移植物组,并发症发生率无显著差异(术后感染,外侧铰链骨折,和持续的疼痛)。
OBJECTIVE: The use of synthetic bone substitute material (BSM) as osteotomy gap fillers have been reported to improve outcomes in medial opening wedge high tibial osteotomy (MOWHTO). This
study aims to evaluate the early radiological outcomes (bone union) and complication rates of the novel patient-specific 3D-printed honeycomb-structured polycaprolactone and tricalcium phosphate (PCL-TCP) synthetic graft compared to allogeneic bone grafts as an osteotomy gap filler in MOWHTO.
METHODS: A retrospective matched-pair analysis of patients who underwent MOWHTO with either PCL-TCP synthetic graft or allogenic femoral head
allograft as osteotomy gap filler was performed. The osteotomy gap was split into equal zones (Zone 1-5), and bone union was evaluated on anteroposterior radiographs based on the van Hemert classification at 1, 3, 6, and 12 months postoperatively. Postoperative complications including infection, lateral hinge fractures, and persistent pain was measured. The
study and control group were matched for age, smoking status, diabetes mellitus, and osteotomy gap size.
RESULTS: Significantly greater bone union progression was observed in the PCL-TCP group than in the
allograft group at 1 month (Zones 1-3), 3 months (Zones 1-4), 6 months (Zones 1-2, 4), and 12 months (Zones 2-3, 5) postoperatively (P < 0.05). No significant difference in complications rates was noted between the two groups at 1 year.
CONCLUSIONS: Bone union rates observed in patients who underwent MOWHTO with the PCL-TCP synthetic graft osteotomy gap filler were superior to those in the
allograft group at 1 year postoperatively, with no significant difference in complication rates (postoperative infection, lateral hinge fractures, and persistent pain).