3D打印钛合金骨小梁金属臼杯全髋关节置换术的短期疗效

The early-term clinical efficacy of titanium trabecular metal acetabular components produced by E-beam technologyintotal hip-arthroplasty

目的评估3D打印钛合金骨小梁金属（titaniumtrabecularmetal，TTM）臼杯在初次全髋关节置换术（totalhiparthroplasty，THA）中应用的短期疗效。方法2012年5月至2013年6月，选取19例（20髋）进行初次全髋关节置换术的患者按采用臼杯类型不同分为TrM组和Pinnacle组。TTM组9例（10髋），男7例，女2例；年龄54～65岁，平均（61．0±3．5）岁。Pinnacle组10例（10髋），男6例，女4例；年龄51～67岁，平均（61．3±4．8）岁。术后6、12和24周进行随访，通过影像学检查评估髋臼假体的稳定性和髋臼表面与骨界面的骨长人能力；采用sF-36健康调查量表、WOMAC健康调查表和Harris髋关节功能评分评估患者关节功能。结果TFM组术后6个月，Harris髋关节功能评分由术前平均（48．2±5．5）分提高到（89．5±4．0）分，sF-36健康调查量表分值由术前（329．1±86．7）分提高到（763．8～15．1）分，WOMAC健康调查表分值由（18．8±11．0）分改善到（1．3±0．9）分，差异均有统计学意义。与Pinnacle组（术后6个月）比较，Harris髋关节功能评分、sF-36健康调查量表分值、WOMAC健康调查表分值两组的差异均无统计学意义。两组术后影像学评估显示术后臼杯稳定，无松动及移位；所有患者均未出现进行性增加的透亮线。TFM组2例髋臼假体植入后存在透亮线，均位于2区和3区，术后6个月随访时透亮线消失；l例髋臼后壁存在骨缺损，行股骨头骨块植骨后髋臼假体稳定，随访过程中植骨块与臼杯接触紧密，未出现松动现象。结论全髋关节置换术中采用3D打印钛合金骨小梁金属臼杯的初始稳定性好、早期骨长人良好，短期疗效满意；长期效果有待于进一步随访结果。

Objective To explore the early-term efficacy of porous titanium trabecular metal acetabular （TTM） compo- nents produced by E-beam technology in total hip arthroplasty（THA）. Methods From May 2012 to JUN 2013, nineteen primary THA patients （20 hips） were devided into observation group of porous TTM acetabular prosthesis produced by E-beam technology and control group of Pinnacle acetabular prosthesis. TFM group had nine patients （10 hips）, including 7 males and 2 females, with the mean age of 61.0 years. Pinnacle group had ten patients （10 hips）, including 6 males and 4 females, with the mean age of 58.6 years. The patients were followed up at the 6, 12,24 weeks after operation. X-rays were taken at the follow-ups. Acetabular compo- nent stability and osseointegration were assessed through radiograph. Harris scores system, SF-36 Heath Survey Questionnaire and WOMAC Osteoarthritis index were recorded before and after operation to evaluate clinical effects of surgery. Results In TTM group, the Harris score improved from 48.2±5.5 preoperatively to 89.5±4.0 postoperatively, SF-36 scores from 329.1±86.7 to 763.8±15.1, and WOMAC index from 18.8±11.0 to 1.3±0.9. No cases suffered aseptic loosening and migration. After 24 weeks, There was no significant difference regarding Harris scores system, SF-36 Heath Survey Questionnaire and WOMAC Os- teoarthritis index between two groups. In TTM group, two hips had a radiolucent line postoperatively, which occurred in 2 and 3 zone. The lines were disappeared 24 weeks later. Conclusion In THA, the initial stability of TTM produced by E-beam tech- nology was fine, which can facilitate bone ingrowth in early stage. However, the long-term follow-up effect still needs to be con- firmed.