混合现实可视化技术在胫骨近端高位截骨治疗膝关节骨关节炎中的应用研究

Research on the application of mixed reality visualization technology in the treatment of knee osteoarthritis with high tibial osteotomy

摘要:

目的 探讨混合现实可视化技术治疗膝关节骨关节炎的应用效果及安全性，提高手术治疗膝关节骨关节炎的治疗效率及安全性。方法 选取2020年1月—2025年1月沈阳市骨科医院收治的膝关节骨关节炎患者102例，其中52例采用混合现实可视化技术辅助胫骨高位截骨术（HTO）的患者作为观察组，50例采用3D导板辅助HTO的患者作为对照组。评估两组患者术前、术后视觉模拟评分法（VAS）评分、膝关节功能Lysholm评分、西安大略和麦克马斯特大学骨关节炎指数（WOMAC），测量两组患者手术前后胫骨后倾角（PTS）、股胫角（FTA）、胫骨近端内侧角（MPTA）。记录两组手术时间、止血带时间、术中透视X射线剂量。观察两组术后并发症发生情况。结果 观察组与对照组术前、术后3个月、术后6个月的静息状态下测量VAS评分比较，结果 ①不同时间点的VAS评分比较，差异有统计学意义（P <0.05）；②观察组与对照组VAS评分比较，差异无统计学意义（P >0.05）；③观察组与对照组的VAS评分变化趋势比较，差异无统计学意义（P >0.05）。观察组与对照组术后术前、术后3个月、术后6个月的Lysholm、WOMAC评分比较，结果 ①不同时间点的Lysholm、WOMAC评分比较，差异均有统计学意义（P <0.05）；②观察组与对照组的Lysholm、WOMAC评分比较，差异均无统计学意义（P >0.05）；③观察组与对照组的Lysholm、WOMAC评分变化趋势比较，差异均无统计学意义（P >0.05）。观察组与对照组术前、术后3个月、术后6个月的PTS、FTA、MPTA比较，结果 ①不同时间点的PTS、FTA、MPTA比较，差异均有统计学意义（P <0.05）；②观察组与对照组的PTS、FTA、MPTA比较，差异均有统计学意义（P <0.05），观察组与对照组相比PTS、FTA较低，MPTA较高；③观察组与对照组的FTA、MPTA变化趋势比较，差异均有统计学意义（P <0.05），观察组与对照组的PTS变化趋势比较，差异无统计学意义（P >0.05）。观察组手术时间、止血带时间均短于对照组（P <0.05），术中透视X射线剂量低于对照组（P <0.05）。对照组与观察组并发症总发生率比较，差异无统计学意义（P >0.05）。结论 混合现实可视化技术与3D打印导板技术功能疗效同等优异，安全性均较高，且可改善患者膝关节功能，提高手术效率，减少术中透视X射线剂量。

Abstract:

Objective To explore the application effect and safety of mixed reality visualization technology in the treatment of knee osteoarthritis (KOA), and to improve the treatment efficiency and safety of KOA surgery.Methods A total of 102 patients with KOA admitted to our hospital from January 2020 to January 2025 were selected. Among them, 52 patients who underwent high tibial osteotomy (HTO) assisted by mixed reality visualization technology were assigned to the observation group, and 50 patients who underwent HTO assisted by a 3D-printed guide plate were assigned to the control group. The visual analogue scale (VAS) scores, knee joint function Lysholm scores, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores of the two groups before and after surgery were evaluated. The posterior tibial slope (PTS), femorotibial angle (FTA), and proximal medial tibial angle (MPTA) of the two groups before and after surgery were measured. The operation time, tourniquet time, and intraoperative X-ray radiation dose of the two groups were recorded. The occurrence of postoperative complications was observed in both groups.Results For VAS scores at preoperative, 3 months postoperative, and 6 months postoperative: (1) there were significant differences across different time points (P < 0.05); (2) there were no significant differences between the two groups (P > 0.05); (3) the changing trends of VAS scores did not differ significantly between the two groups (P > 0.05). For Lysholm and WOMAC scores: (1) there were significant differences across different time points (P < 0.05); (2) there were no significant differences between the two groups (P > 0.05); (3) the changing trends of Lysholm and WOMAC scores did not differ significantly between the two groups (P > 0.05). For PTS, FTA, and MPTA: (1) there were significant differences across different time points (P < 0.05); (2) there were significant differences between the two groups (P < 0.05), with the observation group showing lower PTS and FTA and higher MPTA than the control group; (3) the changing trends of FTA and MPTA differed significantly between the two groups (P < 0.05), while the changing trend of PTS did not differ significantly between the two groups (P > 0.05). The observation group had significantly shorter operation time and tourniquet time, and lower intraoperative X-ray radiation dose than the control group (all P < 0.05). There was no statistically significant difference in the overall incidence of complications between the two groups (P > 0.05).Conclusion Mixed reality visualization technology and 3D-printed guide plate technology have equally excellent functional efficacy and safety profiles. Both can improve knee joint function in patients, enhance surgical efficiency, and reduce intraoperative X-ray radiation dose.