3D打印技术在全髋关节置换术治疗复杂髋关节疾病中的应用价值

Application of 3D printing in total hip arthroplasty for complex hip joint diseases

目的:评价3D打印技术辅助全髋关节置换术(THA)治疗复杂髋关节疾病的早期疗效及安全性。方法:回顾性分析2013年1月至2018年12月收治的采用3D打印技术辅助THA治疗的11例并发髋臼或股骨缺损的复杂髋关节畸形患者。其中4例为左侧髋关节结核,1例为左侧髋关节骨巨细胞瘤病理性股骨颈骨折,6例为复杂髋关节翻修术。术前行CT及MRI检查,结合3D打印技术,重建骨盆模型,设计髋臼及股骨柄,制定出个性化髋关节假体进行手术模拟以确定最合适的手术计划。记录患者术前及术后3个月、6个月、18个月西安大略和麦克马斯特大学(WOMAC)骨关节炎指数量表评分、髋关节功能Harris评分及疼痛视觉模拟量表(VAS)评分,术后第1天、术后3个月、6个月、18个月测量患者双下肢长度,同时观察并发症发生情况。结果:11例患者均顺利完成手术。11例患者术后3个月、6个月、18个月WOMAC评分均较术前降低,Harris评分均较术前升高,且差异均有统计学意义(P<0.001,P=0.001)。术后3个月VAS评分低于术前,且差异有统计学意义(P<0.001),术后6个月时所有患者的疼痛基本已消失,术后18个月时所有患者的疼痛已完全消失。术后第1天、术后3个月、6个月、18个月所有患者双下肢均等长,无一例患者发生并发症。结论:3D打印技术辅助TKA治疗复杂髋关节疾病具有良好的早期疗效及安全性,可减少手术时间,提高手术精准性。

Objective:To evaluate the early efficacy and safety of 3 D printing-assisted total hip arthroplasty(THA)for complex joint diseases of the hip.Methods:We retrospectively analyzed 11 patients with complex hip joint deformities combined with acetabulum or femur defects who were treated with 3 D printing-assisted THA between January 2013 and December 2018.There were 4 cases of tuberculosis of the left hip,1 case of pathological femoral neck fracture caused by giant cell tumor of the left hip,and 6 cases of hip revision surgery.All the patients underwent preoperative CT and MRI examinations.The pelvis model was reconstructed in combination with 3 D printing technology.Personalized hip prosthesis was developed for surgical simulation to determine the most appropriate surgical plan.Western Ontario and McMaster Universities osteoarthritis index(WOMAC),Harris hip score and visual analogue scale(VAS)score were evaluated preoperatively and 3,6,and 18 months postoperatively.The length of lower limbs were measured at 1 day,3,6,and 18 months postoperatively.Results:Eleven patients were successfully operated.The WOMAC scores were significantly decreased and Harris hip scores were significantly increased at 3,6,and 18 months after the operation(P<0.001,P=0.001).The VAS score at 3 months after surgery was significantly lower than that before surgery(P<0.001).The pain of all the patients basically disappeared at 6 months after surgery,and completely disappeared at 18 months after surgery.All the patients had the same length of both lower limbs on the 1 st day,at 3 months,6 months and 18 months postoperatively,and no complications occurred.Conclusions:3 D printing-assisted THA can reduce operation time and achieve good early curative effect,safety and accuracy in the treatment of complex hip joint diseases.