3D打印钛金属加强块和Jumbo臼杯重建髋臼骨缺损早期临床疗效的对比研究

Comparison of short-term clinical efficacy between three dimension printed titanium augments and Jumbo cup for the reconstruction of acetabular bone defects

背景:在髋关节翻修术中,骨科医师如何重建严重的髋臼骨缺损是一个挑战。Jumbo臼杯可以很好地重建髋臼骨缺损,但面临软组织撞击。3D打印技术能够精确地匹配和解剖重建严重的髋臼骨缺损,其临床疗效有待于进一步观察。目的:对比分析髋关节翻修术中使用3D打印钛金属加强块和Jumbo臼杯重建髋臼骨缺损的早期临床疗效。方法:回顾性分析2015年6月至2017年10月行髋关节翻修术治疗存在髋臼骨缺损的40例患者的病例资料,术中使用3D打印钛金属加强块或Jumbo臼杯进行骨缺损重建,分为3D打印钛金属加强块组18例,Jumbo臼杯组22例。记录患者一般资料、手术时间、出血量,以及术前和末次随访Harris评分、下肢长度变化以及术后并发症情况。结果:40例全部获得随访,随访时间24~37个月,平均(30.3±5.8)个月。两组患者的一般资料、手术时间、出血量比较,差异无统计学意义(P>0.05)。术前髋关节Harris评分,Jumbo臼杯组为40~54分,平均(46.7±7.2)分,3D打印钛金属加强块组为42~52分,平均(45.2±7.6)分,两组比较差异无统计学意义(P>0.05)。末次随访髋关节Harris评分,Jumbo臼杯组为79~89分,平均(85.1±6.8)分,3D打印钛金属加强块组为77~90分,平均(86.8±7.3)分,两组比较差异无统计学意义(P>0.05)。两组术后Harris评分均较术前有明显改善(P<0.05)。术后随访结果显示,Jumbo臼杯组2例发生髋关节脱位,其余患者髋臼假体稳定,未发生假体周围关节感染、假体周围骨折等并发症。两组术后并发症发生率比较,差异有统计学意义(P<0.05)。结论:3D打印钛金属加强块和Jumbo臼杯均能够重建严重髋臼骨缺损,早期疗效满意。3D打印钛金属加强块重建髋臼骨缺损较Jumbo臼杯发生髋关节脱位的风险更低,推荐使用。

Background:It’s a challenge for orthopedists to reconstruct acetabular bone defects in revision total hip arthroplasty.Although it is reported Jumbo cup can reconstruct acetabular bone defects effectively,impingement of soft tissue will occur.Three dimension printed augment can provide accurate match of acetabular defects and reconstruct acetabular bone defects anatomically,but its clinical outcomes still need be observed.Objective:To compare the short-term clinical efficacy of three dimension printed titanium augments and Jumbo cup for the reconstruction of acetabular bone defects in revision total hip arthroplasty.Methods:Clinical data of 40 patients with severe acetabular bone defects undergoing revision total hip arthroplasty by three dimension printed titanium augments or Jumbo cup from June 2015 to October 2017 were retrospectively analyzed.All patients were divided into two groups:three dimension printed titanium augment group of 18 patients and Jumbo cup group of 22 patients.The clinical data including general information,operation time,volume of bleeding,preoperative and final follow-up Harris score of hip,limb-length discrepancy and postoperative complications were recorded.Results:All patients were followed up for 24-37 months with(30.3±5.8)months on average.There was no statistically significant difference in the general information,operation time,volume of bleeding between the two groups(P>0.05).Harris hip score was 40~54 with(46.7±7.2)on average in the Jumbo cup group and 42~52 with(45.2±7.6)on average in the three dimension printed titanium augment group before the operation,and the difference was not statistically significant between the two groups(P>0.05).At the final follow-up,Harris hip score was 79~89 with(85.1±6.8)on average in the Jumbo cup group and 77~90 with(86.8±7.3)on average in the three dimension printed titanium augment group,and the difference was not statistically significant between the two groups(P>0.05).There was significant difference in Harris hip score after the operation compared with before the operation in both groups(P<0.05).The final follow-up data showed that the acetabular prosthesis and augments were stable,and there was no periprosthetic fracture,periprosthetic jointinfection orothercomplicationsexcepttwo hip jointsdislocation in Jumbo cup group.There was statistical difference in the incidence of postoperative complications between the two groups(P<0.05).Conclusions:Three dimension printed augments and Jumbo cup both can reconstruct severe acetabular bone defects and the short-term outcomes are satisfactory.Three dimension printed titanium augment has less risk of hip joint dislocation in treatment of acetabular bone defects,which is worthy of being recommended in revision total hip arthroplasty.