3D打印辅助重建重度骨缺损翻修患者髋臼旋转中心的疗效

Study on the Efficacy of 3D Printing Assisted Acetabular Rotation Center Reconstruction in Revision Patients with Severe Bone Defects

目的探讨应用个体化3D打印钛合金臼杯重建重度骨缺损髋臼旋转中心病例的早期临床效果。方法选取2017年1月至2018年12月安徽医科大学附属宿州医院收治的应用个体化3D打印钛合金臼杯重建重度骨缺损髋臼旋转中心的10例患者。其中男4例,女6例;年龄36~67岁,平均(54.71±10.23)岁。术前Paprosky髋臼骨缺损分型,ⅡB型3例,ⅢA型7例。记录手术时间、术中出血量;手术前后及随访期间的骨盆X线片髋关节旋转中心(hip joint center,HJC)的位置信息;髋关节的Harris功能评分和术后并发症等,评估该项技术的早期临床效果。结果10例患者手术时间为1.51~3.12 h,平均(1.81±0.82)h。术中出血量为650~1750 mL,平均(983.43±459.22)mL。随访时间为13~26个月,平均(18.35±4.51)个月。患者术后髋臼旋转中心恢复至较理想位置。髋关节Harris功能评分:术前26~45分,平均(34.02±14.91)分;末次随访时78~97分,平均(84.31±9.71)分,两者比较差异有统计学意义(P<0.01)。10例患者随访至今未见假体关节脱位、假体关节感染、假体周围骨折等并发症。术后随访期间骨盆X线片均未见个体化3D打印臼杯与其宿主骨之间放射性透光线和假体松动。术后6个月随访时X线片示3D臼杯周围骨组织结合紧密、固定可靠,有较好的骨长入。结论应用个体化3D打印钛合金臼杯能够重建重度骨缺损髋臼的旋转中心,术后肢体长度和髋关节功能均有显著改善,3D臼杯与缺损的宿主骨匹配佳,早期随访临床疗效好。

Objective To study the early clinical outcomes of individualized 3D-printed titanium alloy socket cups in reconstruction of acetabular rotation center in patients with severe bone defects.Methods Ten patients admitted to our hospital from January 2017 to December 2018 accepted individualized 3D-printed titanium alloy cups to reconstruct the acetabular rotation centre of severe bone defects.4 males and 6 females were included.The patients aged 36 to 67 years,with an average of(54.71±10.23).According to Paprosky acetabular defects classification,there were 3 cases ofⅡB,7 cases ofⅢA.The intraoperative bleeding and operating time,the position of the hip joint center(HJC)on pelvic radiographs before and after surgery and the Harris functional score of the hip joint and postoperative complications were collected to evaluate the early clinical results of this technique.Results The operative time of the 10 patients ranged from 1.51 to 3.12 h,with a mean of(1.81±0.82)h.The intraoperative bleeding volume ranged from 650 to 1750 mL,with a mean of(983.43±459.22)mL.The follow-up period ranged from 13 to 26 months,with a mean of(18.35±4.51)months.The patient's postoperative acetabular centre of rotation improved significantly.Hip Harris function scores were 26 to 45 points before surgery,with an average of(34.02±14.91)points.And hip Harris function scores were 78 to 97 points at the last follow-up,with an average of(84.31±9.71)points.The difference was statistically significant(P<0.01).10 patients had no complications such as prosthetic joint dislocation,prosthetic joint infection or periprosthetic fracture during the follow-up period.No radiolucent lines between the individual 3D printed socket cup and its host bone and no loosening of the prosthesis were observed on any of the pelvic radiographs during the postoperative follow-up period.At the 6-month postoperative follow-up,radiographs showed that the bone tissue around the 3D-printed cup was tightly integrated and reliably fixed,with good bone ingrowth.Conclusion The use of individualized 3D-printed titanium cups was able to reconstruct the centre of rotation of the acetabulum with severe bone defects,and there was significant improvement in limb length and hip function after surgery.