髋膝关节翻修术中的关键问题及3D打印应对之策

Three dimentional printing solutions for conundrum of revision total hip and knee arthroplasties

人工关节置换术是髋膝关节终末期疾病的有效治疗手段。我国人口老年化逐渐加重,关节置换的患者越来越多,初次置换术后由于假体松动、假体周围感染、假体周围骨折、聚乙烯磨损引起的骨缺损严重影响着患者的预后,需要翻修的患者也逐渐增加。现阶段,人工髋膝关节翻修中主要面临的难题有:骨缺损处理、术前规划、个性化假体需求。随着软件工程技术、材料技术的不断发展,3D打印技术将为复杂的髋膝关节置换翻修带来新的解决方案。3D打印技术在关节外科手术有以下方面的应用:优化术前规划、个性化手术;个性化内固定材料;个性化术中导航模板的制作;个性化假体设计。本文就髋膝关节翻修中的关键问题及3D打印技术在其中的应用进展作简要综述。

Total hip arthroplasty （THA） and total knee arthroplasty （TKA） appear to be the terminal treatments for the hip and knee joint diseases. With the senile population gradually increase in this country, the patients who need joint arthroplasty surgery become more and more common. However, the bone loss following primary THA and TKA may affect the prognosis, which is caused by prosthetic loosening, periprosthetic infections, periprosthetic fracture or polyethylene wear. The amount of revision THA and TKA cases increased every year. The main difficulties of the revision surgery of THA and TKA include： the solution for bone loss, the plan for surgery and the personalized prosthesis. With the development of software engineering technology and material technology, three dimentional （3D） printing brings up a new way for complicated THA and TKA revision. The application of 3D printing technique in the field of joint surgery is listed as follows： optimal operation plan to achieve personalized surgery; personalized internal fixation biomaterial; personalized navigation template; personalized prosthesis. This review introduced the main reasons of THA and TKA revision and the application of 3D printing technology.