3D打印技术在Paprosky Ⅲ型髋臼缺损中的应用

Application of 3D printing technology in revision hip replacement for Paprosky type Ⅲ acetabular bone defect

[目的]介绍3D打印技术在Paprosky Ⅲ型髋臼骨缺损翻修中的应用。[方法] 2014年6月～2016年12月收治的髋关节置换术后需行翻修手术且为Paprosky Ⅲ型髋臼骨缺损的患者14例。术前根据CT扫描通过工作站重建CAD (computer aided design)数据模型,3D打印技术打印患侧髋臼实体模型并模拟手术,翻修术中将术前打印好的个体化活性钛填充块修补缺损髋臼,重建髋关节的解剖旋转中心,置入假体并保证髋关节的初始稳定性。[结果]术后影像学显示髋臼侧骨缺损被活性钛金属块填充,髋关节旋转中心得以解剖重建,假体位置良好。术后13个月患髋Harris评分为(86.93±4.06)分,SF-36评分(95.07±6.34)分。近期临床效果满意。[结论] 3D打印技术应用于Paprosky Ⅲ型髋臼缺损的翻修手术中,能够成功直观的完成术前模拟手术,个体化打印填充块解剖修复缺损髋臼,提高手术疗效及患者满意度。

[Objective]To introduce the 3D printing technology applied in revision hip replacement for Paprosky type Ⅲ acetabular bone defects.[Methods]From June 2014 to December 2016,14 patients underwent revision hip replacement for primary THA failure accompanied with Paprosky type Ⅲ acetabular bone defects.According to the CT scanning preoperatively,a digital model was created by CAD software.After that the entity model of the pelvis was made by 3D printing to .mimic surgical operation.During the revision surgery,an individualized titanium filling block previously made by 3D printing was implanted into the acetabular bone defects to restore the the anatomical hip rotation center,and then the acetabular component was enclosed with proper initial stability.[Results]The postoperative radiographs revealed that perfect bone defect filling,righteous reconstruction of the rotation center and proper position of acetabular component were acquired in all patients.At 13 months after operation,the clinical outcomes proved satisfactory,associated with Harris score of (86.93±4.06)and SF-36 score of (95.07±6.34).[Conclusion]The 3D printing technology is a powerful approach to mimic revision procedure before operation,supply an individualized titanium implants for filling bone defects,and improve the surgical efficacy and patient's satisfaction in revision hip replacement for Paprosky type Ⅲ acetabular bone defects.