3D打印钛合金骨小梁杯联合抗骨质疏松治疗的早期临床疗效

Early clinical efficacy of 3D printed titanium trabecular metal cup combined with anti-osteoporosis treatment

目的探讨3D打印钛合金骨小梁杯联合抗骨质疏松治疗在原发性骨质疏松患者初次全髋关节置换中的早期临床疗效。方法回顾性分析2015年11月至2019年6月本院使用骨小梁杯行初次全髋关节置换122例(129髋)患者的资料,根据不同治疗方案分为钛杯组A 49例(52髋),钛杯组B 42例(44髋),钽杯组31例(33髋),钛杯组A与钽杯组随访期间均规范抗骨质疏松治疗,钛杯组B随访期间拒绝抗骨质疏松治疗。比较3组患者术前、术后及末次随访的Harris评分、SF-12健康评分,统计术后并发症,通过影像学评估髋臼侧骨长入情况。结果122例患者随访6~48个月,平均随访23.7个月。所有患者术后Harris评分、SF-12健康评分较术前改善,差异具有统计学意义(P<0.05);术后首次及末次Harris评分、SF-12健康评分:钛杯组A与钛杯组B差异有统计学意义(P<0.05),钛杯组A与钽杯组差异无统计学意义(P>0.05)。随访期间钛杯组B有3例患者出现髋部疼痛,2例患者髋臼侧出现透亮线,末次随访时3组患者均未出现臼杯松动、骨溶解、假体周围骨折及感染等并发症,影像学提示髋臼侧均有良好骨长入,臼杯未见外展角变化,髋臼Ⅱ区骨量差异无统计学意义(P>0.05)。结论3D打印钛合金骨小梁杯联合抗骨质疏松治疗能获得良好的初始稳定及骨长入效果,其早期疗效与钽金属骨小梁杯比较,差异无统计学意义,但中远期疗效仍需进一步研究;初次全髋置换术后规范抗骨质疏松治疗,能促进患者早期功能恢复及整体健康水平提高,预防术后并发症。

Objective To explore the early clinical efficacy of 3D printed titanium trabecular metal cup combined with anti-osteoporosis treatment in the first total hip arthroplasty for patients with primary osteoporosis.Methods Clinical data of 122 patients(129 hips)with primary osteoporosis undergoing the first total hip arthroplasty through using trabecular cup in our hospital from November 2015 to June 2019 were selected to carry on retrospective analysis.According to different treatment schemes,patients were divided into titanium group A 49 patients(52 hips),titanium group B 42 patients(44 hips)and tantalum group 31 patients(33 hips).During the follow-up period,standardized anti-osteoporosis treatment was used in the titanium group A and the tantalum group while the anti-osteoporosis treatment was refused to use in the titanium group B.Preoperative,postoperative and the last follouw-up Harris score and SF-12 health score among the titanium group A,B and tantalum group were respectively compared,the postoperative complications were recorded,and the bone ingrowth around acetabular component was evaluated by radiological examination.Results 122 patients were followed up for 6 to 48 months and followed up for an average of 23.7 months.Through comparing with those before operation,it was found that Harris score and SF-12 health score of the three groups were significantly improved,the differences were statistically significant(P<0.05).The first and the last follow-up Harris scores and SF-12 health scores were compared and the results were as follows:There was significant statistical difference in scores between the titanium group A and B(P<0.05),and there was no significant statistical difference in scores between the titanium group A and tantalum group(P>0.05).During the follow-up period,hip pain occurred in 3 patients and radiolucent lines appeared in 2 patients in titanium group B,at the last follow-up,there were no complications such as acetabular bone trabecular cup loosening,osteolysis,periprosthetic fracture and infection in patients of the three groups,all patients'bone ingrowth and no change of abduction angle was showed by radiological examination,and the bone mass in acetabularⅡarea was no significant statistical difference(P>0.05).Conclusion①3D printed titanium trabecular metal cup combined with anti-osteoporosis treatment can be used in obtaining good effect of initial stability and bone ingrowth,its early clinical efficacy is not signific antly different from tantalum trabecular cup,however still it needs further study in medium and long term efficacy.②The standard anti-osteoporosis treatment after the first total hip arthroplasty can effectively promote the early functional recovery and overall health improvement,and prevent postoperative complications.