3D打印术前规划辅助髋臼周围截骨治疗早期发育性髋关节脱位

Treatment of early developmental dislocation of the hip by periacetabular osteotomy assisted by preoperative 3D printing planning

目的探讨3D打印术前规划辅助髋臼周围截骨(PAO)治疗早期发育性髋关节脱位(DDH)的疗效。方法回顾性分析2015年5月至2019年4月期间贵州省人民医院骨科收治的39例(44髋)CROWEⅠ型DDH患者资料。按照治疗方法不同分为2组:观察组19例22髋,男4例(4髋),女15例(18髋);年龄为[23(19,39)]岁;采用3D打印术前规划辅助PAO治疗。对照组20例22髋,男2例(2髋),女18例(20髋);年龄为[23(20,29)]岁;仅采用PAO治疗。比较两组患者的手术时间、术中出血量、住院时间及术中透视次数、Wiberg中心-边缘角、臼顶倾斜角、髋臼覆盖率、末次随访时髋关节Harris评分及并发症发生情况等。结果两组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。所有患者术后获6~12个月(9.6个月)随访。观察组患者的手术时间[100(90,120)min]、术中出血量[160(150,180)mL]、住院时间[6(5,7)d]、术中透视次数[24(22,25)次]均优于对照组患者[140(100,157)min、200(180,250)mL、9(7,11)d、28(24,32)次],差异有统计学意义(P<0.05)。但两组患者术后即刻Wiberg中心-边缘角、臼顶倾斜角、髋臼覆盖率、末次随访时髋关节Harris评分及并发症发生率的比较差异均无统计学意义(P>0.05)。结论虽然PAO治疗早期DDH效果确切,但是3D打印术前规划辅助可以有效减少手术时间、术中出血量、住院时间及术中透视次数,二者结合的疗效较单独应用PAO更好。

Objective To investigate the effect of periacetabular osteotomy(PAO)assisted by preoperative 3D printing planning on the treatment of early developmental dislocation of the hip(DDH).Methods A retrospective study was conducted of the 39 patients(44 hips)with CROWE typeⅠDDH who had been treated at Department of Orthopaedics,Guizhou Provincial People's Hospital from May 2015 to April 2019.In the observation group of 19 patients(22 hips)who were treated by PAO assisted by preoperative 3D printing planning,there were 4 males(4 hips)and 15 females(18 hips)with a mean age of 23(19,39)years;in the control group of 20 patients(22 hips)who were treated by mere PAO,there were 2 males(2 hips)and 18 females(20 hips)with a mean age of 23(20,29)years.The 2 groups were compared in terms of operation time,intraoperative bleeding,hospital stay,fluoroscopic frequency,Wiberg lateral center-edge angle(LCE),acetabular index(AC),acetabulum coverage rate,Harris hip scores(HHS)and complications at the final follow-up.Results There were no significant differences between the 2 groups in their preoperative general data,showing compatibility of the 2 groups(P>0.05).Both groups were successfully followed up for 6 to 12 months(mean,9.6 months).The operation time[100(90,120)min],intraoperative bleeding[160(150,180)mL],hospital stay[6(5,7)d],and fluoroscopic frequency[24(22,25)times]in the observation group were all significantly better than those in the control group[140(100,157)min,200(180,250)mL,9(7,11)d and 28(24,32)times]in the control group(P<0.05).However,there were no significant differences between the 2 groups in LCE,AC or acetabulum coverage rate immediately after operation,or in HHS or complications at the final follow-up(P>0.05).Conclusions Although PAO has a definite therapeutic effect on early DDH,PAO assisted by preoperative 3D printing planning can effectively reduce operation time,intraoperative bleeding,hospital stay and intraoperative fluoroscopy.Thus,combination of the two can result in a better therapeutic effect than PAO alone.