3D打印技术辅助髋臼成形术治疗脑瘫儿童髋关节脱位

Acetabular plasty assisted by 3D printing for the treatment of dislocation of hip joint in children with cerebral palsy

目的:探讨通过3D打印技术明确髋臼发育不良类型选择最合适的髋臼成形术治疗脑瘫儿童髋关节脱位的适应证和临床疗效。方法:自2019年7月至2019年12月,采用3D打印技术辅助髋臼成形术治疗7例脑瘫儿童髋关节脱位,其中男3例,女4例;年龄3~8岁;左侧3例,右侧2例,双侧2例;2例髋关节半脱位,5例髋关节脱位。患儿术前均行骨盆-双股骨全长CT扫描。通过3D打印重建技术,判断髋臼发育不良类型:前侧2髋,前外2髋,外上1髋,后侧2髋,后外1髋,无发育不良1髋(未做髋臼成形术)。对8髋分别进行Pemberton,Dega和San Diego手术模拟,寻找最合适的手术方式并手术。比较术前和末次随访外移比例(migration percentage,MP),髋臼指数(acetabular index,AI),中心边缘角(center-edge angle,CEA),Shenton线和粗大运动功能分级(gross motor function classification system,GMFCS)的变化,并记录其并发症情况。结果:术后患者伤口愈合良好,无并发症发生。7例患者获随访,时间18~24个月。8髋Ⅰ期行软组织松解+股骨近端内翻去旋转短缩截骨+髋关节复位+髋臼成形术;1髋Ⅰ期行软组织松解+股骨近端内翻去旋转短缩截骨+髋关节复位术。MP由术前的58%~100%降至末次随访时的0~17.9%。AI由术前的25.0°~47.6°降至末次随访时的11.1°~25.3°。CEA由术前的0°改善至末次随访时的21.1°~48.5°。Shenton’线均由中断变为连续。其中5例GMFCS分级下降1级,2例无变化。结论:脑瘫儿童髋关节脱位中髋臼发育不良的类型多样,髋臼成形术适用范围也有差异,借助3D打印技术计算机模拟手术可选择最合适的手术方式并判断治疗效果,对脑瘫儿童髋关节脱位做到个体化、精准化治疗。

Objective:To identify types of acetabular dysplasia,select the most suitable acetabular plasty,and analyze indications and efficacy of three types of acetabular plasty in treating dislocation of hip joint in children with cerebral palsy by 3D printing technology.Methods:From July 2019 to December 2019,7 children with cerebral palsy with hip dislocation were treated with acetabular plasty assisted by 3D printing technology,including 3 males and 4 females,aged from 3 from 8 years old;3 patients on the left side,2 patients on the right side,and 2 patients on both sides.Subluxation of hip joint occurred in 2 patients and dislocation of hip joint occurred in 5 patients.Preoperative full-length CT scan of pelvis and femur was performed in all children.The types of acetabular dysplasia were determined by 3D printing reconstruction technology,and the results were presented as follows:2 anterior hips,2 anterior outer hips,1 outer upper hip,2 posterior hips,1 posterior outer hip,and 1 hip without dysplasia(with no acetabular plasty).Pemberton,Dega and San Diego surgery simulations were performed on the 8 hips respectively to find the most suitable and the suitable operations were then conducted.Migration percentage(MP),acetabular index(AI)and cenal-edge angle(CEA),Shenton line,and gross motor function classification system(GMFCS)between preoperative and last follow-up were compared and complications were recorded.Results:The wound healed well after operation and no complication occurred.Seven patients were followed up for 18 to 24 months.The 8 hips were underwent soft tissue release for the first stage+proximal femoral varus and rotation reduction osteotomy+hip reduction+acetabular plasty;1 hip was underwent soft tissue release for the first stage+proximal femoral varus removal and rotation reduction osteotomy+hip reduction.MP decreased from 58% to 100% preoperatively to 0 to 17.9% at the latest follow-up.AI decreased from 25.0°to 47.6°preoperatively to 11.1°to 25.3°at the latest follow-up.CEA increased from 0°preoperatively to 21.1°to 48.5°at the latest follow-up.Shenton's lines changed from interrupted ones to continuous ones.The GMFCS grade of 5 cases decreased by 1 grade,and 2 cases showed no change.Conclusion:There is diversity for the hip dislocation of hip in children with cerebral palsy of acetabular dysplasia present type.Accurate judgments could be made with the help of 3D printing reconstruction techniques.There are differences between scopes of applications for three kinds of acetabulum keratoplasty.3D printing technology could be helpful to choose the most suitable operation method and estimate the treatment effect.Thus the individualized and accurate treatment for hip dislocation in children with cerebral palsy can be gained with 3D printing technology.