3D打印钛合金骨小梁金属臼杯及组件重建PaproskyⅡ、Ⅲ型髋臼骨缺损的中期疗效分析

3D printing trabecular titanium acetabular components in paprosky typeⅡandⅢacetabular defects:medium-term result

目的PaproskyⅡ型和Ⅲ型髋臼缺损是全髋关节翻修术中常见的缺损。在髋臼侧翻修手术中重建骨丢失时,3D打印钛合金骨小梁组件包括金属臼杯和各种组件是一种选择。本研究的目的是分析使用3D打印钛合金骨小梁臼杯和组件修复PaproskyⅡ型和Ⅲ型髋臼缺损的中期结果。方法2015年1月至2018年12月在郑州市骨科医院对23例患者(23髋)使用3D打印钛合金骨小梁金属臼杯及组件进行全髋关节翻修术。其中PaproskyⅡ型缺损19例,PaproskyⅢ型缺损4例。随访期间进行临床和影像学评估。结果23例患者手术时平均年龄66.3岁(58~79岁),平均随访60.1个月(40~78个月)。术后Harris髋关节评分平均为88.3分(68.5~89.0分)。X线片显示,术后髋关节旋转中心与对侧髋关节比较,平均垂直差异为上移1.9 mm(下移4 mm~上移15 mm,P>0.05),差异无统计学意义。术后髋关节旋转中心与对侧髋关节比较,平均水平差异为外移1.4 mm(外移4 mm~内移4 mm,P>0.05),差异无统计学意义,无影像学松动病例,均无需进行翻修手术。结论3D打印钛合金骨小梁髋臼及组件重建治疗PaproskyⅡ型和Ⅲ型髋臼骨缺损的中期随访结果满意。

Objective Paprosky typeⅡandⅢacetabular defects are commonly seen in revision total hip arthroplasty.3D printing trabecular titanium acetabular components including cups and augments are one option when reconstructing bone loss during acetabular side revision surgery.The purpose of the present study was to determine the medium-term results of acetabular revision using 3D printing trabecular titanium acetabular components for Paprosky typeⅡandⅢacetabular defects.Methods Revision total hip arthroplasty with 3D printing trabecular titanium acetabular components was performed on 23 hips in 23 patients from 2015 to 2018 in Orthopaedics Hospital of Zhengzhou.There were 19 cases of Paprosky typeⅡand 4 cases of Paprosky typeⅢ.Both clinical and radiographical assessments were performed during the follow-up period.Results The 23 patients with mean age of 66.3 years(58-79)at the time of operation were followed-up for an average of 60.1 months(40-78).The average Harris hip score was 88.3(68.5-89.0).Radiography displayed the average vertical difference of hip centers was 1.9 mm superiorly when the postoperative hip centers were compared to their contralateral hips(4 mm inferiorly to 15 mm superiorly;P>0.05).The average horizontal difference of hip centers was 1.4 mm medially when postoperative hip centers were compared to their contralateral hips(4 mm laterally to 4 mm medially;P>0.05).There were no cases of radiological loosening during the follow-up period and none of them required revision surgery.Conclusion Acetabular reconstruction with the use of 3D printing trabecular titanium acetabular components for Paprosky typeⅡandⅢacetabular defects showed satisfactory clinical and radiographic results at a medium-term follow-up period.