3D打印导板辅助内侧单髁置换术后早期步态改善但伸膝功能仍不全：一项观察性自身对照研究

王志鹏; 黄海洪; 何锐; 杨鹏飞; 眭文

doi:10.16016/j.2097-0927.202606113

您当前的位置：

首页 >

文章列表页 >

3D打印导板辅助内侧单髁置换术后早期步态改善但伸膝功能仍不全：一项观察性自身对照研究

临床医学 | 更新时间：2026-09-16

- 3D打印导板辅助内侧单髁置换术后早期步态改善但伸膝功能仍不全：一项观察性自身对照研究
- Early gait improvement but persistent knee extension deficit after medial unicompartmental knee arthroplasty assisted by 3D-printed patient-specific instrumentation: an observational self-controlled study
- 陆军军医大学学报 2026年48卷第17期页码：2476-2484
- 作者机构：
  
  1.陆军军医大学（第三军医大学）第一附属医院创伤关节外科，重庆
  2.重庆市中医院骨伤科（关节与运动医学科），重庆
- 作者简介：
  
  何锐，E-mail：abba315@163.com
- 基金信息：
  
  重庆科卫联合面上项目(2024MSXM062)
- DOI：10.16016/j.2097-0927.202606113
  中图分类号： R318.17;R684.05;R687.4
- 收稿：2026-06-30，
  
  修回：2026-07-24，
  
  录用：2026-07-30，
  
  纸质出版：2026-09-15
- 稿件说明：
移动端阅览
王志鹏，黄海洪，何锐，等.3D打印导板辅助内侧单髁置换术后早期步态改善但伸膝功能仍不全：一项观察性自身对照研究［J］.陆军军医大学学报，2026，48（17）：2476-2484.DOI：10.16016/j.2097-0927.202606113.

Wang Z P，Huang H H，He R，et al.Early gait improvement but persistent knee extension deficit after medial unicompartmental knee arthroplasty assisted by 3D-printed patient-specific instrumentation： an observational self-controlled study［J］.J Army Med Univ，2026，48（17）：2476-2484.DOI：10.16016/j.2097-0927.202606113.
王志鹏，黄海洪，何锐，等.3D打印导板辅助内侧单髁置换术后早期步态改善但伸膝功能仍不全：一项观察性自身对照研究［J］.陆军军医大学学报，2026，48（17）：2476-2484.DOI：10.16016/j.2097-0927.202606113. DOI：

Wang Z P，Huang H H，He R，et al.Early gait improvement but persistent knee extension deficit after medial unicompartmental knee arthroplasty assisted by 3D-printed patient-specific instrumentation： an observational self-controlled study［J］.J Army Med Univ，2026，48（17）：2476-2484.DOI：10.16016/j.2097-0927.202606113. DOI：

摘要

目的

内侧单髁置换术（unicompartmental knee arthroplasty，UKA）是治疗膝关节内侧间室骨关节炎的有效保膝术式，3D打印导板辅助技术可提升假体安放精准度，但术后功能恢复尚缺乏客观量化证据，且缺乏与正常人群的对比研究。本研究旨在通过三维步态分析，评估导板辅助内侧UKA术后早期膝关节矢状面运动学恢复规律，明确术后步态异常的具体表现。

方法

采用观察性自身对照（患/健侧）研究设计方案，纳入2024年11月至2025年5月于西南医院创伤关节外科行3D打印导板辅助内侧UKA的24例（25侧膝盖）患者为观察组，选择15侧无症状对侧膝盖作为对照组。分别于术前及术后3个月进行采集髋-膝-踝（hip-knee-ankle，HKA）角、美国西部Ontario与McMaster大学骨关节炎指数（Western Ontario and McMaster University Osteoarthritis Index，WOMAC）评分及矢状面膝关节运动学参数，作组内（观察组术前与术后比较）及组间（观察组术前、术后分别与对照组比较）对比分析。

结果

观察组患者随访时间为2.90~6.73个月，平均（4.15±1.12）个月。观察组术后WOMAC评分（0.92±1.44

12.76±3.94）、僵硬评分（0.88±1.09

2.84±2.34）、功能评分（2.72±3.02

47.80±12.08）较术前

均显著改善（

0.001）；观察组术后HKA角较术前显著增加［（177.14±2.48）

（171.44±4.21）°，

0.001］，内翻畸形明显矫正，较对照组［（177.02±3.11）°］无统计学差异。观察组术后摆动相最大屈曲角度［（60.51±5.20）

（47.13±12.68）°，

0.001］与术前相比显著增加，承重反应期占比（10.36%±3.32%

15.84%±11.43%，

=0.029）与术前相比显著缩短，与对照组比较无统计学差异；观察组术后支撑相最小屈曲角度［（10.63±5.85）

（6.14±5.04）°，

=0.018］、摆动相最小屈曲角度［（7.62±5.28）

（3.26±5.24）°，

=0.015］、承重反应期屈曲范围［（6.84±3.03）

（9.75±2.89）°，

=0.005］与对照组比较仍存在统计学差异，提示伸膝功能尚未完全恢复。其余步态参数差异无统计学意义。

结论

3D打印导板辅助UKA术后早期，患者步态过程中承重反应期占比、膝关节摆动相最大屈曲角度明显改善。但与对照健侧相比，步态过程中仍存在伸膝不全，主要表现为支撑相最小屈曲角度、摆动相最小屈曲角度的增大。

Abstract

Objective

Medial unicompartmental knee arthroplasty (UKA) is an effective knee-preserving procedure for medial compartment knee osteoarthritis. Procedures assisted by 3D-printed patient-specific instrumentation (PSI) can improve the accuracy of prosthesis positioning. However

objective quantitative evidence regarding postoperative functional recovery remains insufficient

and few studies have included comparisons with normal populations. This study aims to evaluate the early postoperative recovery pattern of sagittal knee kinematics following PSI-assisted medial UKA

via

3D gait analysis

and to identify specific manifestations of postoperative gait abnormalities.

Methods

An observational self-controlled (affected

contralateral limb) study design was adopted. Twenty-four patients (25 knees) who underwent 3D-printed PSI-assisted medial UKA in Department of Trauma and Joint Surgery of First Affiliated Hospital of Army Medical University between November 2024 and May 2025 were enrolled as the observation group

and 15 asymptomatic contralateral knees were selected as the c

ontrol group. The hip-knee-ankle (HKA) angle

Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score

and sagittal knee kinematic parameters were collected preoperatively and at 3 months postoperatively. Intragroup comparisons (preoperative

postoperative data within the observation group) and intergroup comparisons (preoperative and postoperative data of the observation group

the control group) were performed.

Results

The patients in the observation group were followed up for 2.90 to 6.73 (4.15±1.12) months. Regarding functional scores and radiographic outcomes: postoperative WOMAC score (0.92±1.44

12.76±3.94)

stiffness score (0.88±1.09

2.84±2.34)

and function score (2.72±3.02

47.80±12.08) in the observation group were significantly improved compared with preoperative values (all

0.001). The postoperative HKA angle in the observation group was significantly larger than the preoperative value [(177.14±2.48)

(171.44±4.21)°

0.001

]

with obvious correction of varus deformity

but there was no significant difference in the angle between the postoperative HKA angle and the control group [(177.02±3.11)°

]

. In gait analysis: the peak knee flexion angle during swing phase was significantly increased postoperatively compared with preoperatively [(60.51±5.20)

(47.13±12.68)°

0.001

]

and the proportion of loading response phase was decreased significantly (10.36%±3.32%

15.84%±11.43%

=0.029)

both recovering to the levels of the control group. However

significant differences were observed between postoperative patients and the control group in term of the minimum knee flexion angle during stance phase [(10.63±5.85)

(6.14±5.04)°

=0.018

]

minimum knee flexion angle during swing phase [(7.62±5.2

(3.26±5.24)°

=0.015

]

and knee flexion range during loading response [(6.84±3.03)

(9.75±2.89)°

=0.005

]

which suggested that knee extension function had not been fully restored. No statistically significant differences were found in the remaining gait parameters.

Conclusion

In the early postoperative period after 3D-printed PSI-assisted UKA

the patients present significant improvement in the loading response phase proportion and the maximum knee flexion angle during swing phase. However

incomplete knee extension persists during gait relative to the control group

as evidenced by increased minimum knee flexion angles during both stance and swing phases.

关键词

Keywords

references

Franz A ， Boese C K ， Matthies A ， et al . Mid-term clinical outcome and reconstruction of posterior tibial slope after UKA ［J］. J Knee Surg ， 2019 ， 32 （ 5 ）： 468 - 474 . DOI： 10.1055/s-0038-1651528 http://dx.doi.org/10.1055/s-0038-1651528 .

Heyse T J ， El-Zayat B F ， De Corte R ， et al . UKA closely preserves natural knee kinematics in vitro ［J］. Knee Surg Phys Traumatol Arthrosc ， 2014 ， 22 （ 8 ）： 1902 - 1910 . DOI： 10.1007/s00167-013-2752-0 http://dx.doi.org/10.1007/s00167-013-2752-0 .

Patient relevant outcomes of unicompartmental versus total knee replacement： systematic review and meta-analysis ［J］. BMJ ， 2019 ， 365 ： l1032 . DOI： 10.1136/bmj.l1032 http://dx.doi.org/10.1136/bmj.l1032 .

Woon J T K ， Zeng I S L ， Calliess T ， et al . Outcome of kinematic alignment using patient-specific instrumentation versus mechanical alignment in TKA： a meta-analysis and subgroup analysis of randomised trials ［J］. Arch Orthop Trauma Surg ， 2018 ， 138 （ 9 ）： 1293 - 1303 . DOI： 10.1007/s00402-018-2988-8 http://dx.doi.org/10.1007/s00402-018-2988-8 .

Sun M L ， Zhang Y ， Peng Y ， et al . Gait analysis after total knee arthroplasty assisted by 3D-printed personalized guide ［J］. BioMed Res Int ， 2020 ， 2020 ： 6485178 . DOI： 10.1155/2020/6485178 http://dx.doi.org/10.1155/2020/6485178 .

孙茂淋，杨柳，何锐，等 . 3D打印导板辅助人工全膝关节置换术后患者步态分析［J］. 中国修复重建外科杂志， 2019 ， 33 （ 8 ）： 953 - 959 . DOI： 10.7507/1002-1892.201902068 http://dx.doi.org/10.7507/1002-1892.201902068 .

Sun M L ， Yang L ， He R ， et al . Gait analysis after total knee arthroplasty assisted by three-dimensional printing navigation template ［J］. Chin J Reparative Reconstr Surg ， 2019 ， 33 （ 8 ）： 953 - 959 . DOI： 10.7507/1002-1892.201902068 http://dx.doi.org/10.7507/1002-1892.201902068 .

孙旭东，邵安泽，顾飞，等 . 3D打印个性化截骨模块导板辅助膝关节单髁置换术治疗骨关节炎的临床效果［J］. 医学研究与战创伤救治， 2025 ， 38 （ 2 ）： 180 - 185 . DOI： 10.16571/j.cnki.2097-2768.2025.02.011 http://dx.doi.org/10.16571/j.cnki.2097-2768.2025.02.011 .

Sun X D ， Shao A Z ， Gu F ， et al . Clinical effect of 3D printed personalized osteotomy module guide plate assisted unicompartmental knee ar-throplasty for the treatment of osteoarthritis ［J］. J Med Res Combat Trauma Care ， 2025 ， 38 （ 2 ）： 180 - 185 . DOI： 10.16571/j.cnki.2097-2768.2025.02.011 http://dx.doi.org/10.16571/j.cnki.2097-2768.2025.02.011 .

Gadeyne S ， Menon A ， Lustig S . Long-term outcomes of a 3D printed cementless fixed bearing unicompartmental knee arthroplasty ［J］. Arch Orthop Trauma Surg ， 2025 ， 145 （ 1 ）： 339 . DOI： 10.1007/s00402-025-05952-3 http://dx.doi.org/10.1007/s00402-025-05952-3 .

任鹏鹏，张启栋 . 膝活动平台内侧单髁置换术后生物力学的研究进展［J］. 中国矫形外科杂志， 2022 ， 30 （ 4 ）： 329 - 332 . DOI： 10.3977/j.issn.1005-8478.2022.04.09 http://dx.doi.org/10.3977/j.issn.1005-8478.2022.04.09 .

Ren P P ， Zhang Q D . Research progress on biomechanics secondary to Oxford mobile-bearing medial unicompartmental knee arthroplasty ［J］. Orthop J China ， 2022 ， 30 （ 4 ）： 329 - 332 . DOI： 10.3977/j.issn.1005-8478.2022.04.09 http://dx.doi.org/10.3977/j.issn.1005-8478.2022.04.09 .

El-Galaly A ， Kappel A ， Nielsen P T ， et al . Revision risk for total knee arthroplasty converted from medial unicompartmental knee arthroplasty： comparison with primary and revision arthroplasties， based on mid-term results from the Danish knee arthroplasty registry ［J］. J Bone J Surg ， 2019 ， 101 （ 22 ）： 1999 - 2006 . DOI： 10.2106/jbjs.18.01468 http://dx.doi.org/10.2106/jbjs.18.01468 .

Liow M H ， Tsai T Y ， Dimitriou D ， et al . Does 3-dimensional in vivo component rotation affect clinical outcomes in unicompartmental knee arthroplasty ［J］. J Arthroplasty ， 2016 ， 31 （ 10 ）： 2167 - 2172 . DOI： 10.1016/j.arth.2016.03.003 http://dx.doi.org/10.1016/j.arth.2016.03.003 .

Servien E ， Fary C ， Lustig S ， et al . Tibial component rotation assessment using CT scan in medial and lateral unicompartmental knee arthroplasty ［J］. Orthop Traumatol Surg Res ， 2011 ， 97 （ 3 ）： 272 - 275 . DOI： 10.1016/j.otsr.2010.11.002 http://dx.doi.org/10.1016/j.otsr.2010.11.002 .

Hsu R W ， Himeno S ， Coventry M B ， et al . Normal axial alignment of the lower extremity and load-bearing distribution at the knee ［J］. Clin Orthop Relat Res ， 1990 （ 255 ）： 215 - 227 .

Favre J ， Jolles B M . Gait analysis of patients with knee osteoarthritis highlights a pathological mechanical pathway and provides a basis for therapeutic interventions ［J］. EFORT Open Rev ， 2016 ， 1 （ 10 ）： 368 - 374 . DOI： 10.1302/2058-5241.1.000051 http://dx.doi.org/10.1302/2058-5241.1.000051 .

李伟，汪宗保，李国平，等 . 膝关节骨性关节炎患者步态运动学参数的研究［J］. 中国康复医学杂志， 2008 ， 23 （ 1 ）： 11 - 13 . DOI： 10.3969/j.issn.1001-1242.2008.01.003 http://dx.doi.org/10.3969/j.issn.1001-1242.2008.01.003 .

Li W ， Wang Z B ， Li G P ， et al . The research of gait kinematics parameters in the knee osteoarthritis patients ［J］. Chin J Rehabil Med ， 2008 ， 23 （ 1 ）： 11 - 13 . DOI： 10.3969/j.issn.1001-1242.2008.01.003 http://dx.doi.org/10.3969/j.issn.1001-1242.2008.01.003 .

李宏恩，马恺，石春花，等 . 步态分析用于膝骨性关节炎诊断与功能评定的研究进展［J］ . 生物医学工程与临床， 2024 ， 28 （ 2 ）： 281 - 286 . DOI： 10.13339/j.cnki.sglc.20240223.019 http://dx.doi.org/10.13339/j.cnki.sglc.20240223.019 .

Li H E ， Ma K ， Shi C H ， et al . Progress in gait analysis for diagnosis and functional assessment of knee osteoarthritis ［J］. Biomed Eng Clin Med ， 2024 ， 28 （ 2 ）： 281 - 286 . DOI： 10.13339/j.cnki.sglc.20240223.019 http://dx.doi.org/10.13339/j.cnki.sglc.20240223.019 .

Mündermann A ， Dyrby C O ， Andriacchi T P . Secondary gait changes in patients with medial compartment knee osteoarthritis： increased load at the ankle， knee， and hip during walking ［J］. Arthritis Rheum ， 2005 ， 52 （ 9 ）： 2835 - 2844 . DOI： 10.1002/art.21262 http://dx.doi.org/10.1002/art.21262 .

Malus J ， Urbaczka J ， Rygelova M ， et al . Effect of footwear type on biomechanical risk factors for knee osteoarthritis ［J］. Orthop J Sports Med ， 2023 ， 11 （ 7 ）： 23259671231183416 . DOI： 10.1177/23259671231183416 http://dx.doi.org/10.1177/23259671231183416 .

刘志宏，何川，冯建民，等 . 单髁膝关节置换术后膝关节三维运动学特性研究［J/OL］. 中华关节外科杂志（电子版）， 2013 ， 7 （ 4 ）： 438 - 442 . DOI： 10.3877/cma.j.issn.1674-134X.2013.04.002 http://dx.doi.org/10.3877/cma.j.issn.1674-134X.2013.04.002 .

Liu Z H ， He C ， Feng J M ， et al . Three dimentional kinematics study of knee after unicompartmental arthroplasty ［J/OL］. Chin J Jt Surg Electron Version ， 2013 ， 7 （ 4 ）： 438 - 442 . DOI： 10.3877/cma.j.issn.1674-134X.2013.04.002 http://dx.doi.org/10.3877/cma.j.issn.1674-134X.2013.04.002 .

Suter L ， Roth A ， Angst M ， et al . Is ACL deficiency always a contraindication for medial UKA Kinematic and kinetic analysis of implanted and contralateral knees ［J］. Gait Posture ， 2019 ， 68 ： 244 - 251 . DOI： 10.1016/j.gaitpost. 2018.11.031 http://dx.doi.org/10.1016/j.gaitpost.2018.11.031 .

郝朋，杨柳，何锐，等 . 人工单髁关节置换术后步态及临床疗效分析［J］. 中国修复重建外科杂志， 2020 ， 34 （ 11 ）： 1369 - 1375 . DOI： 10.7507/1002-1892.202004076 http://dx.doi.org/10.7507/1002-1892.202004076 .

Hao P ， Yang L ， He R ， et al . Analysis of gait and effectiveness after unicompartmental knee arthroplasty ［J］. Chin J Reparative Reconstr Surg ， 2020 ， 34 （ 11 ）： 1369 - 1375 . DOI： 10.7507/1002-1892.202004076 http://dx.doi.org/10.7507/1002-1892.202004076 .

Nha K W ， Shon O J ， Kong B S ， et al . Gait comparison of unicompartmental knee arthroplasty and total knee arthroplasty during level walking ［J］. PLoS One ， 2018 ， 13 （ 8 ）： e0203310 . DOI： 10.1371/journal.pone.0203310 http://dx.doi.org/10.1371/journal.pone.0203310 .

Bączkowicz D ， Skiba G ， Czerner M ， et al . Gait and functional status analysis before and after total knee arthroplasty ［J］. Knee ， 2018 ， 25 （ 5 ）： 888 - 896 . DOI： 10.1016/j.knee.2018.06.004 http://dx.doi.org/10.1016/j.knee.2018.06.004 .

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

膝关节精准治疗：从结构修复到功能重塑的演进与展望

Nutlin-3a-PLGA微球促大鼠脊髓损伤后的运动功能恢复

神经系统疾病的早期起源：低出生体质量与多发性硬化因果关系的孟德尔随机化研究证据

FABP4抑制剂BMS309403通过调控FABP4/PPAR-γ信号轴减轻肝肺综合征大鼠肝肺损伤

个人特质是影响人体热耐力的核心因素：基于健康生态学模型的多因素交互作用分析