Objective: To compare the efficacy of conventional open ankle fusion and three dimensional(3D) printed guide plate assisted arthroscopic ankle fusion. Methods: A retrospective cohort study was performed on 256 patients with advanced traumatic ankle arthritis, who were admitted to the Department of Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from May 2018 to February 2023 and underwent ankle fusion procedures. The study cohort comprised 119 males and 137 females, with an age of (59.6±9.5) years (range: 37 to 83 years). Among them, 175 cases underwent internal fixation with plates and screws (58 cases through the combined medial and lateral approach, and 117 cases through the simple lateral approach), 48 cases underwent internal fixation with screws through the anterior approach (conventional open group), and 33 cases underwent minimally invasive arthroscopic ankle fusion assisted by 3D printed guide plate (3D printed guide plate arthroscopy group). Propensity score matching was employed to achieve a 1∶1 match(caliper value=0.02) between the baseline characteristics of patients in the 3D printed guide plate arthroscopy group and the conventional open group. Perioperative and follow-up data between the two groups were compared using the t-test, Mann-Whitney U test, Wilcoxon signed rank test,χ² test, or Fisher's exact probability method, as appropriate. Results: Matching was successfully achieved with 20 cases in both the 3D printed guide plate arthroscopy group and the conventional open group, and there were no statistically significant differences in baseline characteristics between the two groups (all P>0.05). The operation time in the 3D printed guide plate arthroscopy group was significantly longer than that in the conventional open group ((88.9±5.6) minutes vs. (77.9±11.7) minutes;t=-2.392, P=0.022), while the frequency of intraoperative fluoroscopies ((1.7±0.8) times vs. (5.2±1.2) times; t=10.604, P<0.01) and length of hospitalization ((5.5±0.9) days vs. (6.4±1.5) days;t=2.480, P=0.018) were significantly lower in the 3D printed guide plate arthroscopy group compared to the conventional open group. The fusion rate was 95.0% (19/20) in the 3D printed guide plate arthroscopy group and 85.0% (17/20) in the conventional open group, with no statistically significant difference between the two groups (χ²=1.111,P=0.605). The fusion time was (12.1±2.0) weeks in the conventional open group and (11.1±1.7) weeks in the 3D printed guide plate arthroscopy group, with no statistically significant difference between the two groups (t=1.607, P=0.116). At the final follow-up, the American Orthopedic Foot and Ankle Society ankle hindfoot scale was (72.6±5.5)points in the 3D printed guide plate arthroscopy group and (70.5±5.8)points in the conventional open group, with no statistically significant difference between the two groups (t=-1.003, P=0.322). The VAS score of the 3D printed guide plate arthroscopy group was (M(IQR)) 1.50 (1.00) points, lower than that of the conventional open group by 3.00 (1.00) points, with statistically significant differences (Z=-3.937, P<0.01). The complication rate was significantly higher in the conventional open group (25.0%(5/20) vs. 5.0%(1/20), P=0.182). Conclusion: 3D printed guide plate assisted arthroscopic ankle fusion exhibited several advantages, including reduced frequency of fluoroscopies, alleviation of postoperative pain, and decreased complications and length of hospitalization.
目的： 比较三维打印导板辅助关节镜下微创踝关节融合术和传统开放式踝关节融合术治疗晚期踝关节炎的临床效果。 方法： 本研究为回顾性队列研究。回顾性分析2018年5月至2023年2月上海交通大学医学院附属第六人民医院骨科收治的256例行踝关节融合术的晚期创伤性踝关节炎患者资料。男性119例，女性137例，年龄（59.6±9.5）岁（范围：37~83岁）。其中行接骨板螺钉内固定（外侧+内侧双入路58例，单纯外侧入路117例）175例；行传统开放式前路螺钉内固定48例（传统开放组）；行三维打印导板辅助关节镜下微创踝关节融合术33例（三维打印导板组）。采用倾向性评分匹配对三维打印导板组和传统开放组患者的基本资料进行1︰1匹配，卡钳值为0.02。采用独立样本t检验、Mann-Whitney U检验、Wilcoxon 符号秩检验、χ²检验或Fisher确切概率法对患者围手术期数据及随访资料进行比较。 结果： 三维打印导板组和传统开放组各20例匹配成功，术前基本资料的差异均无统计学意义（P值均>0.05）。与传统开放组相比，三维打印导板组的手术时间更长［（88.9±5.6）min 比（77.9±11.7）min；t=-2.392，P=0.022］，但术中透视次数更少［（1.7±0.8）次比（5.2±1.2）次，t=10.604，P<0.01］，住院时间更短［（5.5±0.9）d比（6.4±1.5）d；t=2.480，P=0.018］，差异均有统计学意义。三维打印导板组的融合率为95.0%（19/20），传统开放组为85.0%（17/20），组间差异无统计学意义（χ²=1.111，P=0.605）；传统开放组的融合时间为（12.1±2.0）周，三维打印导板组为（11.1±1.7）周，组间差异无统计学意义（t=1.607，P=0.116）。末次随访时，三维打印导板组的美国足踝矫形学会踝-后足评分为（72.6±5.5）分，传统开放组为（70.5±5.8）分，差异无统计学意义（t=-1.003，P=0.322）；三维打印导板组的疼痛视觉模拟评分为［M（IQR）］1.50（1.00）分，低于传统开放组的3.00（1.00）分，差异有统计学意义（Z=-3.937，P<0.01）。传统开放组的并发症发生率更高［25.0%（5/20）比5.0%（1/20），P=0.182］。 结论： 三维打印导板辅助关节镜进行踝关节融合术与传统开放手术相比，手术时间略长，但在减少术中透视次数、减轻术后疼痛、减少并发症和缩短住院天数方面有一定优势。.