3D打印个性化多孔钛金属支架重建髋臼骨缺损的中期疗效评估

The medium-term outcomes of 3D printed customized porous titanium acetabular prosthesis replacement for acetabular bone defection

目的:探讨应用3D打印个性化多孔钛金属支架重建髋臼骨缺损的可行性、安全性、初始稳定性及中期临床疗效。方法:采用3D打印个性化多孔钛金属支架重建12例髋臼骨缺损患者,利用计算机对患者髋臼骨缺损进行三维建模,设计个性化多孔钛金属支架模型,再利用钛合金3D打印完成个性化支架的实体加工成型,并对实体部件进行喷砂、超声波振荡、高温处理、消毒等后处理。通过髋关节外侧入路显露髋关节,植入个性化髋臼支架,记录手术时间、术中出血量及并发症发生情况。术后门诊随访,分别采用视觉模拟度量表(visual analogue scale,VAS)和Harris功能评分评估患髋局部疼痛和髋关节功能情况,结合髋关节X线及CT扫描分析髋关节力线恢复情况,骨缺损与支架的匹配度和包容性。结果:12例手术时间1.1~3.5 h,平均(2.23±0.7)h;术中出血量150~820 mL,平均(406.67±219.29)mL;随访时间为12~26个月,平均15.33个月,患者关节功能恢复满意,VAS评分由术前(5.17±1.53)分下降至术后1年(1.67±0.78)分(t=9.225,P<0.001),Harris功能评分由术前(47.67±7.15)分升高至术后1年(86.75±4.52)分(t=-27.380,P<0.001)。术后复查髋关节X线及CT扫描显示:关节假体位置良好、关节力线恢复满意,髋臼骨缺损区与金属支架之间紧密接触、无松动。结论:3D打印个性化多孔钛金属支架能够重建髋臼骨缺损,增加髋关节的初始稳定性,降低髋关节重建术的手术难度,术后髋关节功能恢复良好。

Objective:This study aims to explore the feasibility,safety,efficacy and medium-term outcomes of 3D printed customized porous titanium acetabular prosthesis in treating acetabular bone defection. Methods:Twelve patients with acetabular bone defection[8 male and 12 female,with a mean age of(62.25±12.21)years,range 42-82 years]were treated with 3D printed customized porous titanium acetabular prosthesis from January 2016 to September 2017. The 3D printing techniques was used for reconstructing and designing the optimal acetabular prosthesis for the personalized acetabular bone defection of each patient. The acetabular prosthesis was subjected to porous processing. The 3D printing of porous titanium acetabular prosthesis and post-processing was subsequently performed. The acetabular prosthesis was implanted through the lateral approach of hip joint. The operative duration,intraoperative blood loss and complications were recorded. All patients were followed up postoperatively. Pain was assessed using the visual analog scale(VAS),and the hip joint function was evaluated using the Harris score and gait analysis. The patients underwent anterior-posterior radiography and computer tomography of the hip joint aiming to observe the restoration of lower limb alignment and the position of the acetabular prosthesis. Results:The mean operative duration of 12 patients was(2.23±0.7)h(1.1-3.5 h),and the mean blood loss was(406.67±219.29)mL(150-820 mL). All patients were followed up for 12 to 26 months,with an average of 15.33 months. All patients were satisfied with functional restoration. The VAS scores ranged from 5.17±1.53 preoperatively to 1.67±0.78 postoperatively(t=9.225,P < 0.001),and Harris scores ranged from 47.67±7.15 preoperatively to 86.75±4.52 postoperatively(t=-27.380,P < 0.001)with statistically significant difference,respectively. The image suggested good restoration of lower limb alignment and position of the acetabular prosthesis,and a close contact between the titanium acetabular prosthesis and acetabular bone defection without loosening. Conclusion:The 3D printed customized porous titanium acetabular prosthesis could reconstruct the defect of acetabular and increase the initial stability of hip joint. The method could reduce the difficulty of the hip reconstruction,and the patients could obtain good hip joint function.