3D打印骨小梁金属臼杯用于全髋关节置换翻修术的效果

Curative effect of 3D printing trabecular metal acetabular cups in revision of total hip arthroplasty

目的探讨3D打印钛合金骨小梁金属(TTM)臼杯用于全髋关节置换(THA)翻修术的临床效果。方法采用回顾性病例系列研究分析2016年5月至2019年9月青岛大学附属医院收治的24例(25髋)THA翻修患者临床资料,其中男10例,女14例;年龄43~78岁[(63.0 ± 11.4)岁]。PaproskyⅠ型5例(5髋),ⅡA型9例(10髋),ⅡB型5例(5髋),ⅡC型1例(1髋),ⅢA型4例(4髋)。翻修术中均使用3D打印TTM臼杯,有7例(7髋)联合使用3D打印TTM垫块,3例(3髋)联合使用结构性植骨。比较术前、术后3个月、术后12个月及末次随访时视觉模拟评分(VAS)、Harris评分和健康调查简表(SF-36)评分。根据髋关节X线片评估术前、术后第1天及末次随访时患髋旋转中心(HCOR)上移距离、双下肢长度差(LLD),以及末次随访时臼杯位置、骨长入情况。观察术后并发症情况。结果患者均获随访14~54个月[(34.2 ± 9.3)个月]。术后3个月、12个月及末次随访时VAS分别为(4.0 ± 0.7)分、(2.3 ± 0.8)分、(0.9 ± 0.2)分,较术前的(6.1 ± 1.0)分显著降低(P < 0.05),术后3个月、12个月及末次随访时VAS两两比较,差异均有统计学意义(P < 0.05)。术后3个月、12个月及末次随访时Harris评分分别为(64.6 ± 5.3)分、(80.5 ± 3.7)分、(90.3 ± 3.6)分,较术前的(38.9 ± 6.2)分显著提高(P < 0.05),术后3个月、12个月及末次随访时Harris评分两两比较,差异均有统计学意义(P < 0.05)。术后3个月、12个月及末次随访时SF-36评分分别为(556.3 ± 21.9)分、(711.6 ± 15.9)分、(752.8 ± 23.0)分,较术前的(326.3 ± 30.7)分显著提高(P < 0.05),术后3个月、12个月及末次随访时SF-36评分两两比较,差异均有统计学意义(P < 0.05)。术后第1天、末次随访时HCOR上移距离分别为(13.5 ± 2.6)mm、(13.6 ± 2.6) mm,较术前的(34.1 ± 3.5) mm显著降低(P < 0.05)。术后第1天、末次随访时LLD分别为(6.2 ± 1.8) mm、(5.3 ± 1.5) mm,较术前的(31.6 ± 5.2)mm显著降低(P < 0.05)。所有臼杯位置稳定,23髋骨长入良好。1例患者术后伤口愈合不良,其余患者均未出现并发症。结论对于THA翻修患者,翻修术中使用3D打印TTM臼杯可有效减轻疼痛、改善患髋功能、提供良好的生物固定,同时可减少并发症。

Objective To evaluate the curative effect of 3D printing titanium trabecular metal(TTM)acetabular cups in revision of total hip arthroplasty(THA).Methods A retrospective case series study was conducted on the clinical data of 24 patients(25 hips)undergoing THA revision in Affiliated Hospital of Qingdao University from May 2016 to September 2019.There were 10 males and 14 females,aged 43-78 years[(63.0±11.4)years].According to Paprosky classification,5 patients(5 hips)were classified as type Ⅰ,9 patients(10 hips)as type ⅡA,5 patients(5 hips)as type ⅡB,1 patient(1 hip)as type ⅡC and 4 patients(4 hips)as type ⅢC.All patients used 3D printing TTM cups.Seven patients(7 hips)were combined with 3D printing TTM pads,and 3 patients(3 hips)were combined with structural bone grafts.The visual analogue scale(VAS),Harris score and quality of life Health Survey Scale(SF-36)score were evaluated before operation,3 months after operation,12 months after operation and at the last follow-up.The X-ray film of hip joint was performed to evaluate the upward movement distance of hip center of rotation(HCOR),limb-length discrepancy(LLD)before operation,1 day after operation and at the last follow-up.The position of cups and bone ingrowth were evaluated at the last follow-up.The postoperative complications were observed.Results All patients were followed up for 14-54 months[(34.2±9.3)months].The VAS was(4.0±0.7)points,(2.3±0.8)points and(0.9±0.2)points at postoperative 3 months,12 months and the last follow-up,significantly lower than that preoperatively[(6.1±1.0)points](P<0.05).A statistically significant difference was found in the pairwise comparisons of postoperative VAS at postoperative 3 months,12 months and the last follow-up(P<0.05).The Harris score was(64.6±5.3)points,(80.5±3.7)points,and(90.3±3.6)points at postoperative 3 months,12 months and the last follow-up,significantly higher than that preoperatively[(38.8±6.2)points](P<0.05).A statistically significant difierence was found in the pairwise comparisons of postoperative Harris score at postoperative 3 months,12 months and the last follow-up(P<0.05).The SF-36 score was(556.3±21.9)points,(711.6±15.9)points and(752.8±23.0)points at postoperative 3 months,12 months and the last follow-up,significantly higher than that preoperatively[(326.3±30.7)points](P<0.05).A statistically significant difference was found in the pairwise comparisons of postoperative SF-36 score at postoperative 3 months,12 months and the last follow-up(P<0.05).The upward movement distance of HCOR was(13.5±2.6)mm and(13.6±2.6)mm on the first day after operation and at the last follow-up,significantly lower than that preoperatively[(34.1±3.5)mm](P<0.05).The LLD was(6.2±1.8)mm and(5.3±1.5)mm on the first day after operation and at the last follow-up,significantly lower than that preoperatively[(31.6±5.2)mm](P<0.05).All the cups were stable.Good bone ingrowth was found in 23 hips.There was no postoperative complication except for one patient with poor wound healing.Conclusion For THA revision,the use of 3D printing TTM cups can effectively relieve pain,improve hip function,provide satisfactory biological fixation and and reduce complications.